Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group

Baker TS, Kellner CP, Colbourne F, Rincon F, Kollmar R, Badjatia N, Dangayach N, Mocco J, Selim MH, Lyden P, Polderman K, Mayer S (2022)

Publication Type: Journal article

Publication year: 2022

Journal

Frontiers in Neurology Frontiers Research Foundation / Frontiers Media

Book Volume: 13

DOI: 10.3389/fneur.2022.859894

Abstract

Background and purposeTherapeutic hypothermia (TH), or targeted temperature management (TTM), is a classic treatment option for reducing inflammation and potentially other destructive processes across a wide range of pathologies, and has been successfully used in numerous disease states. The ability for TH to improve neurological outcomes seems promising for inflammatory injuries but has yet to demonstrate clinical benefit in the intracerebral hemorrhage (ICH) patient population. Minimally invasive ICH evacuation also presents a promising option for ICH treatment with strong preclinical data but has yet to demonstrate functional improvement in large randomized trials. The biochemical mechanisms of action of ICH evacuation and TH appear to be synergistic, and thus combining hematoma evacuation with cooling therapy could provide synergistic benefits. The purpose of this working group was to develop consensus recommendations on optimal clinical trial design and outcomes for the use of therapeutic hypothermia in ICH in conjunction with minimally invasive ICH evacuation. MethodsAn international panel of experts on the intersection of critical-care TH and ICH was convened to analyze available evidence and form a consensus on critical elements of a focal cooling protocol and clinical trial design. Three focused sessions and three full-group meetings were held virtually from December 2020 to February 2021. Each meeting focused on a specific subtopic, allowing for guided, open discussion. ResultsThese recommendations detail key elements of a clinical cooling protocol and an outline for the roll-out of clinical trials to test and validate the use of TH in conjunction with hematoma evacuation as well as late-stage protocols to improve the cooling approach. The combined use of systemic normothermia and localized moderate (33.5 degrees C) hypothermia was identified as the most promising treatment strategy. ConclusionsThese recommendations provide a general outline for the use of TH after minimally invasive ICH evacuation. More research is needed to further refine the use and combination of these promising treatment paradigms for this patient population.

Authors with CRIS profile

Rainer Kollmar Medizinische Fakultät

Involved external institutions

Icahn School of Medicine at Mount Sinai US United States (USA) (US) University of Alberta CA Canada (CA) Thomas Jefferson University US United States (USA) (US) University of Maryland US United States (USA) (US) Harvard University US United States (USA) (US) University of Southern California (USC) US United States (USA) (US) United Memorial Medical Center (UMMC) US United States (USA) (US) Westchester Medical Center University Hospital (WMC) US United States (USA) (US)

How to cite

APA:

Baker, T.S., Kellner, C.P., Colbourne, F., Rincon, F., Kollmar, R., Badjatia, N.,... Mayer, S. (2022). Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group. Frontiers in Neurology, 13. https://doi.org/10.3389/fneur.2022.859894

MLA:

Baker, Turner S., et al. "Consensus recommendations on therapeutic hypothermia after minimally invasive intracerebral hemorrhage evacuation from the hypothermia for intracerebral hemorrhage (HICH) working group." Frontiers in Neurology 13 (2022).

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