Clinical ReportLong-Term Hypothermia in Patients with Severe Brain Edema After Poor-Grade Subarachnoid Hemorrhage Feasibility and Intensive Care ComplicationsGasser, Stefan; Khan, Nadia; Yonekawa, Yasuhiro; Imhof, Hans-Georg; Keller, Emanuela Author Information Department of Neurosurgery, University Hospital Zurich, Switzerland Address correspondence and reprint requests to E. Keller, MD Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, CH-8091 Zurich, Switzerland (e-mail: [email protected]). Supported by the Department of Neurosurgery, University Hospital Zurich, Switzerland. Accepted for publication on April 1, 2003. Journal of Neurosurgical Anesthesiology: July 2003 - Volume 15 - Issue 3 - p 240-248 Buy Abstract The purpose was to evaluate the feasibility and intensive care complications of long-term hypothermia (>72 hours) in the treatment of severe brain edema after poor-grade subarachnoid hemorrhage (SAH) Hunt and Hess grade 4 to 5. Among 156 patients with SAH, 21 patients were treated with mild hypothermia (33.0 to 34.0°C) combined with barbiturate coma because of severe brain edema and elevated intracranial pressure (>15 mm Hg) after early aneurysm clipping. Hypothermia was sustained for at least 24 hours after maintaining an intracranial pressure of <15 mm Hg. Nine patients were treated for <72 hours (group 1: mean 42.2 hours, range 8–66 hours) and 12 for >72 hours (group 2: mean 153.9 hours, range 78–400 hours). Three patients (14%) died during the hypothermia treatment. Good functional outcome after 3 months (Glasgow Outcome Score 4–5) was achieved in 10 patients (48%). The outcome did not differ between the two groups. All patients developed severe infections. In group 2 the mean value of minimal leukocyte counts during hypothermia was significantly lower (6.9 vs. 11.8 × 109/L; P = 0.001), and thrombocytopenia (<150 × 109/L) occurred significantly more often (48 vs. 33%; P = 0.032). In 48% of patients with poor-grade SAH, good functional outcome was achieved with combined mild hypothermia and barbiturate coma after early aneurysm surgery. This may be a feasible treatment even for longer than 72 hours. All patients developed severe infections as potentially hazardous side effects. To determine whether mild hypothermia alone is effective in the treatment of severe SAH patients, controlled studies to compare the effects of barbiturate coma alone, mild hypothermia alone, and combined barbiturate coma with hypothermia are needed. © 2003 Lippincott Williams & Wilkins, Inc.