Hypothermia in the treatment of refractory intracranial hypertension in patients with severe SAH, cases associated with secondary vasospasms

Subarachnoid hemorrhage (SAH) is a severe disease in which 10% of patients may present sudden death before arriving at the hospital. Patients are exposed to a high risk of secondary complications including vasospasm. For refractory vasospasm and essentially for ICP control, hypothermia may be employed for the treatment.We aimed to evaluate the influence of therapeutic hypothermia in mortality rates of patients with severe SAH with high intracranial pressure despite best clinical treatment. Temperatures were reduced using mattress for a target temperature of 33-35o C. Five patients were included. Two patients were admitted with a Hunt-Hess scale grade of 2, two of 3 and one of 4. The mean length of therapeutic hypothermia was 7.2 days. Two patients survived with a Rankin scale of 0, and three died. In our observational study we observed a 180 days mortality rate of 40% that increased to 60% in six month analysis. Recent trials describe a mortality rate of 90% in patients with SAH and refractory ICH11. We believe hypothermia may be the best method to be employed in this clinical situation.