LAUSR

BACKGROUND Therapeutic hypothermia (TH) offers cerebral protection following ischemic stroke and may improve outcomes in conjunction with decompressive hemicraniectomy (DHC). We aimed to assess the effectiveness of TH in patients with malignant ischemic stroke and DHC. METHODS We performed a meta-analysis in patients with malignant ischemic stroke undergoing DHC comparing TH vs. normothermia in studies published up to August 2019. Included studies had ≥10 adults with acute ischemic stroke. Primary outcome was functional independence and secondary outcomes included complications. Effect size was pooled and described by relative risk (RR) ratios and 95% confidence intervals (CI). RESULTS Five studies (n=269 patients; n=130 TH, n=139 controls) were included, four of which were prospective (n=2 randomized controlled trials). Median achieved body temperature of TH was 33.6°C (range 33-35°C). Median mRS at the study completion was similar between TH and controls (RR 1.08, 95% CI 0.56-2.07, p=0.8). Three studies reported individual patient mRS outcomes demonstrated a shift toward worse outcomes with TH (unadjusted common OR 1.74; 95% CI 1.05-2.88, p=0.01). Overall complications were similar between groups (RR 1.20, 95% CI 0.70-2.05, random-effects p=0.5). A suggestion of higher mortality was seen in TH (RR 1.50, 95% CI 0.97-2.32, p=0.07). CONCLUSIONS Clinical and functional outcomes were not overall different between patients undergoing systemic TH and controls following DHC despite the shift toward worse outcomes with TH observed in some studies.