BackgroundThe effect of hypothermia on large hemispheric infarction (LHI) remains controversial. Our study aimed to explore the therapeutic outcomes of decompressive craniectomy (DC) combined with hypothermia on LHI.MethodsPatients were randomly divided into three groups: the DC group, the DC plus head surface cooling (DCSC) group and the DC plus endovascular hypothermia (DCEH) group. The DC group was maintained normothermia. The DCSC group received 24-h ice cap on the head for 7days. While the DCEH group were given endovascular hypothermia (34 degrees C). Mortality and modified Rankin Scale (mRS) score at 6months were evaluated.ResultsThirty-four patients were included in the study. Mortality of the DC, DCSC and DCEH groups at discharge were 22.2% (2/9), 0% (0/14) and 9.1% (1/11), respectively. However, it increased to 44.4% (4/9), 21.4% (3/14) and 45.5% (5/11) at 6months, respectively (p=0.367). Pneumonia (8 cases) was the leading cause of death after discharge. Twelve cases (35.3%) achieved good neurological outcome (mRS 0-3) at 6months. The proportions of good neurological outcome in the DC, DCSC and DCEH groups were 22.2% (2/9 cases), 42.9% (6/14 cases) and 36.4% (4/11), respectively. The DCSC group seemed to have higher proportion of good outcomes, but there was no significant difference between groups (p=0.598). Among survivors, endovascular hypothermia had a higher proportion of good outcome (DC group, 2/5 cases, 40.0%; DCSC group, 6/11 cases, 54.5%; DCEH group, 4/6 cases, 66.7%; p=0.696). The incidence of complications in the DCEH group was higher than those of the DC and DCSC groups (18.9%, 12.0%, and 12.1%, respectively; p=0.025).ConclusionsThere is still no evidence to confirm that hypothermia further reduces long-term mortality and improves neurological outcomes in LHI patients with DC. However, there is a trend to benefit survivors from hypothermia. A local cooling method may be a better option for DC patients, which has little impact on systematic complications.Trial registrationDecompressive Hemicraniectomy Combined Hypothermia in Malignant Middle Cerebral Artery Infarct, ChiCTR-TRC-12002698. Registered 11 Oct 2012- Retrospectively registered, URL: http://www.chictr.org.cn/showproj.aspx?proj=6854.
基金：
National Key Department of Neurology and Critical Care Medicine - National Health and Family Planning Commission of the People's Republic of China
第一作者机构：[1]Department of Neurology, Xuanwu Hospital Capital Medical University, No. 45 Changchun Street, Xicheng District, Beijing 100053, China
通讯作者：
推荐引用方式(GB/T 7714)：
Fan Linlin,Su Yingying,Zhang Yan,et al.Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial[J].BMC NEUROLOGY.2021,21(1):doi:10.1186/s12883-021-02142-7.
APA：
Fan, Linlin,Su, Yingying,Zhang, Yan,Ye, Hong,Chen, Weibi&Liu, Gang.(2021).Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial.BMC NEUROLOGY,21,(1)
MLA：
Fan, Linlin,et al."Decompressive craniectomy combined with mild hypothermia in patients with large hemispheric infarction: a randomized controlled trial".BMC NEUROLOGY 21..1(2021)
