Feasibility of endovascular and surface cooling strategies in acute stroke Ovesen C, Brizzi M, Pott FC, Thorsen-Meyer HC, Karlsson T, Ersson A, Christensen H, Norrlin A, Meden P, Krieger DW, Petersson J. Feasibility of endovascular and surface cooling strategies in acute stroke. Acta Neurol Scand: 2013: 127: 399–405. © 2012 John Wiley & Sons A/S. Background – Therapeutic hypothermia (TH) is a promising treatment of stroke, but limited data are available regarding the safety and effectiveness of cooling methodology. We investigated the safety of TH and compared the cooling capacity of two widely used cooling strategies – endovascular and surface cooling. Methods – COOLAID Oresund is a bicentre randomized trial in Copenhagen (Denmark) and Malm€ o (Sweden). Patients were randomized to either TH (33°C for 24 h) in a general intensive care unit (ICU) or standardized stroke unit care (control). Cooling was induced by a surface or endovascular- based strategy. Results – Thirty-one patients were randomized. Seven were cooled using endovascular and 10 using surface-based cooling methods and 14 patients received standard care (controls). 14 (45%) patients received thrombolysis. Pneumonia was recorded in 6 (35%) TH patients and in 1 (7%) control. 4 TH patients and 1 control developed massive infarction. 1 TH patient and 2 control suffered asymptomatic haemorrhagic transformation. Mortality was comparable with 2 (12%) in the TH group and 1 (7%) among controls. Mean (SD) duration of hospital stay was 25.0 days (24, 9) in TH and 22.5 days (20.6) in control patients (P = 0.767). Mean (SD) induction period (cooling onset to target temperature) was 126.3 min (80.6) with endovascular cooling and 196.3 min (76.3) with surface cooling (P = 0.025). Conclusions – Therapeutic hypothermia with general anaesthesia is feasible in stroke patients. We noticed increased rates of pneumonia, while the length of hospital stay remained comparable. The endovascular cooling strategy provides a faster induction period than surface cooling. C. Ovesen 1 , M. Brizzi 2 , F. C. Pott 3 , H. C. Thorsen-Meyer 3 , T. Karlsson 4 , A. Ersson 4 , H. Christensen 1 , A. Norrlin 4 , P. Meden 1 , D. W. Krieger 1,5 , J. Petersson 2 1 Department of Neurology, Bispebjerg University Hospital, Copenhagen, Denmark; 2 Department of Neurology, Skane University Hospital, Malm€o, Sweden; 3 Department of Anaesthesiology, Bispebjerg University Hospital, Copenhagen, Denmark; 4 Department of Intensive Care Medicine, Skane University Hospital, Malm€o, Sweden; 5 Department of Neurology, Rigshospitalet - University Hospital of Copenhagen, Copenhagen, Denmark Key words: stroke; hypothermia; cerebral infarction; ischaemic stroke; acute stroke therapy D. W. Krieger, Department of Neurology, Bispebjerg University Hospital, Bispebjerg Bakke 23, 2400 Copenhagen, NV, +45, Denmark Tel.: (0045)-28117047 Fax: (0045)-35313733 e-mail: derkkrieger@gmail.com Accepted for publication October 31, 2012 Introduction In observational studies, body temperature increases after severe stroke (1), and high body temperature is thought to worsen outcome (2). Animal models of cerebral ischaemia suggest that therapeutic hypothermia (TH) improves outcome. Clinical data are still limited, although a recent Cochrane analysis of TH in acute ischaemic stroke suggests a 10% reduction in poor outcomes and mortality, however, not statistically significant (3). Several pilot studies have addressed feasibility and safety of TH (32–33°) in acute stroke (4–13). Shivering, an increased rate of pneumonia, and time to target temperature were identified as main challenges in the management of these patients. Methodological differences between studies conducted so far preclude any conclusions regarding preferred care environment, target tem- perature and preferred cooling strategy. Different methods to induce hypothermia such as surface- based (cooling blankets, ice bags, alcohol or ice water rubs) (4, 8, 9, 11–13) and endovascular- based cooling (5–7, 10, 14) have been utilized. No consensus exists regarding the most effective cool- ing strategy today. In this explorative pilot study, we aimed at comparing the efficacy of surface versus 399 Acta Neurol Scand 2013: 127: 399–405 DOI: 10.1111/ane.12059 Ó 2012 John Wiley & Sons A/S ACTA NEUROLOGICA SCANDINAVICA