Title:Targeted Temperature Management in Spontaneous Intracerebral Hemorrhage: A Systematic Review
Volume: 18
Issue: 12
Author(s): Marlene Fischer, Alois Schiefecker, Peter Lackner, Florian Frank, Raimund Helbok, Ronny Beer, Bettina Pfausler, Erich Schmutzhard and Gregor Broessner*
Affiliation:
- Medical University of Innsbruck, Department of Neurology,Austria
Keywords:
Brain injury, hypothermia, normothermia, perihematomal edema, spontaneous intracerebral hemorrhage, targeted
temperature management, TTM.
Abstract: Background: Fever is common in neurocritical care patients and is associated with poor
outcome. Targeted temperature management (TTM), i.e. therapeutic hypothermia or controlled normothermia,
after acute brain injury has been studied as a neuroprotectant for several decades. In contrast
to pharmacological agents with specific targets TTM affects multiple pathophysiological mechanisms
and is primarily thought to attenuate secondary brain injury. Most promising results have been
obtained from experimental studies on cerebral ischemia or traumatic brain injury showing beneficial
effects of hypothermia on structural and functional outcome.
Objective: The aim of this systematic review of the literature is to provide an overview on preclinical
and clinical data on the use of TTM for intracerebral hemorrhage (ICH). The impact of TTM on structural
changes and functional outcome after induced and spontaneous ICH will be summarized.
Results and Discussion: A positive influence of hypothermia has been observed in animal models of
spontaneous ICH improving, among others, perihematomal edema, blood-brain barrier integrity, inflammation
and thrombin-induced injury. However, results regarding functional outcome are conflicting.
Little data is available on the effect of TTM after spontaneous ICH in humans. Single-center observational
studies have shown reduced perihematomal edema under mild hypothermia and an association
with favorable outcome. However, these beneficial effects on mortality and functional outcome
have not been confirmed in randomized studies so far. Thus, results from ongoing, prospective
randomized-controlled trials are highly anticipated.
