Hypothermia Clinical Trial
Official title:
A Multi-center, Randomized, Controlled Trial to Investigate the Efficacy and Safety of Long-term Therapeutic Hypothermia in Adult Patients With Poor-grade Aneurysmal Subarachnoid Hemorrhage
This study is a prospective, multi-centre, randomized,controlled trial to compare the
efficacy of long-term mild hypothermia with normothermic intensive management in patients
with poor-grade aneurysmal subarachnoid hemorrhage.
The primary hypothesis is that the induction of mild hypothermia (maintained at 32-35℃) for
at least 5 days would improve the outcome of patients at six months post hemorrhage compared
with normothermia.
Aneurysmal subarachnoid hemorrhage (aSAH), especially poor-grade aSAH, is a medical emergency
with very high morbidity and mortality rates. SAH constitutes a major public health concern
in developed and developing countries. There were several clinical trials of hypothermia for
aSAH conducted, however, with conflicting results.
Hypothermia therapy treatment is currently used in our department and other large
neurosurgical centers across China to decrease the intracranial pressure (ICP), mitigate some
of the destructive processes, and improve the functional outcome of patients with poor-grade
aSAH. When the decision was made, the patients would be placed in wrapped cooling blankets or
intravascular cooling device after they were sedated, intubated and mechanically ventilated.
The patients would receive continuous infusions of some drugs using an infusion pump to
prevent shivering. Once the patient's rectal, nasopharyngeal or blood temperature reached
32˚C, it was kept at approximately that temperature (32-35˚C) 3 to 7 days. Then the patients
were passively rewarmed to a temperature of 36 to 37˚C at a rate no greater than 0.25˚C/hour,
by gradual adjustment of the blanket thermostat.
The present multi-center, randomized controlled trials is designed to investigate the
efficacy and safety of long-term (3 days) mild hypothermia versus normothermia on the outcome
of patients with poor-grade aSAH. The primary outcome is the neurological function assessed
at 1,3, 6 months post injury with the Glasgow Outcome Score (GOS). Additionally, the
following data will also be recorded and compared: the baseline data, Glasgow Coma
Score,imaging examination (e.g. CT scan), intracranial pressure, laboratory tests (e.g. blood
routine test, liver and kidney function, blood gas analysis, etc), the complications (e.g.
pneumonia, significant bleeding) and so on.
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