Müller Achim, Lorenz Andreas, Seifert Burkhardt, Keller Emanuela
Neurocritical Care Unit, Department of Neurosurgery, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
Neurocrit Care. 2014 Oct;21(2):207-10. doi: 10.1007/s12028-014-0001-0.
Endovascular cooling is currently used for hypothermia treatment and fever reduction therapy. At the same time, little is known about the risks associated to endovascular cooling in patients treated with an endovascular cooling catheter (ECC).
A retrospective chart review of 122 patients with subarachnoid hemorrhage (SAH) treated with an ECC either for therapeutic hypothermia or for fever reduction was performed. ECC-associated thromboembolic events (TEE) such as pulmonary embolism and thrombosis were recorded and compared between patients treated with an ECC and patients treated only with a central venous line (CVL). Additionally, various laboratory parameters were recorded to determine if they might be related to the frequency of TEE's.
43 Patients were treated with an ECC and 79 with a CVL. Patients in the ECC group suffered more frequently from TEE (37 %) than those with a CVL (5 %). None of the laboratory parameters was associated with an increased TEE risk. The treatment with an ECC alone was a risk factor for a TEE, independent from age as well as from Hunt and Hess grade.
Our data show that the treatment with ECC increases the risk of TEE in SAH patients. Therefore, especially when considered for fever reduction, non-invasive devices for surface cooling should be the first choice.
血管内降温目前用于低温治疗和退热治疗。与此同时，对于使用血管内降温导管（ECC）治疗的患者，与血管内降温相关的风险知之甚少。
对122例接受ECC治疗以进行治疗性低温或退热的蛛网膜下腔出血（SAH）患者进行回顾性病历审查。记录ECC相关的血栓栓塞事件（TEE），如肺栓塞和血栓形成，并在接受ECC治疗的患者与仅接受中心静脉导管（CVL）治疗的患者之间进行比较。此外，记录各种实验室参数以确定它们是否可能与TEE的发生频率相关。
43例患者接受ECC治疗，79例接受CVL治疗。ECC组患者发生TEE的频率（37%）高于CVL组患者（5%）。没有一个实验室参数与TEE风险增加相关。单独使用ECC治疗是发生TEE的一个风险因素，与年龄以及Hunt和Hess分级无关。
我们的数据表明，ECC治疗会增加SAH患者发生TEE的风险。因此，特别是在考虑用于退热时，非侵入性表面冷却设备应作为首选。
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