No association between intraoperative hypothermia or supplemental protective drug
and neurologic outcomes in patients undergoing temporary clipping during cerebral
aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm
Surgery Trial.
Author(s): Hindman BJ, Bayman EO, Pfisterer WK, Torner JC, Todd MM; IHAST Investigators.
Collaborators: Todd M, Hindman B, Clarke W, Chaloner K, Torner J, Davis P, Howard
M, Tranel D, Anderson S, Todd M, Hindman B, Weeks J, Moss L, Winn J, Clarke W,
Chaloner K, Wichman M, Peters R, Hansen M, Anderson D, Lang J, Yoo B, Adams H,
Clifton G, Gelb A, Loftus C, Schubert A, Warner D, Young W, Frankowski R,
Kieburtz K, Prough D, Sternau L, Marler J, Moy C, Radziszewska B, Matta B,
Kirkpatrick P, Chatfield D, Skilbeck C, Kirollos R, Rasulo F, English K, Duffy C,
Pedersen K, Scurrah N, Burnstein R, Prabhu A, Salmond C, Blackwell A, Birrell J,
Jackson S, Kassell N, Pajewski T, Fraley H, Morris A, Alden T, Shaffrey M,
Bogdonoff D, Durieux M, Zuo Z, Littlewood K, Nemergut E, Bedford R, Stone D,
Balestrieri P, Mason J, Henry G, Ting P, Shafer J, Blount T, Kim L, James A,
Farace E, Clark L, Irons M, Sasaki T, Webb K, Short T, Mee E, Ormrod J, Jane J,
Alden T, Heppner P, Olson S, Ellegala D, Lind C, Sheehan J, Woodfield M, Law A,
Harrison M, Davies P, Campbell D, Robertson N, Fry R, Sage D, Laurent S,
Bradfield C, Pedersen K, Smith K, Young Y, Chambers C, Hodkinson B, Biddulph J,
Jensen L, Ogden J, Thayer Z, Lee F, Crump S, Quaedackers J, Wray A, Roelfsema V,
Greif R, Kleinpeter G, Lothaller C, Lothaller E, Pfisterer W, Schatzer R, Salem
C, Kutalek W, Tuerkkan E, Koller L, Weber T, Buchmann A, Merhaut C, Graf M, Rapf
B, Lam A, Newell D, Tanzi P, Lee L, Domino K, Vavilala M, Bramhall J, Souter M,
Britz G, Winn H, Bybee H, Costello T, Murphy M, Harris K, Thien C, Nye D, Han T,
McNeill P, O'Brien B, Cormack J, Wyss A, Grauer R, Popovic R, Jones S, Deam R,
Heard G, Watson R, Evered L, Bardenhagen F, Meade C, Haartsen J, Kruger J, Wilson
M, Maktabi M, Traynelis V, McAllister A, Leonard P, Hindman B, Brian J, Mensink
F, From R, Papworth D, Schmid P, Dehring D, Howard M, Hitchon P, VanGilder J,
Weeks J, Moss L, Manzel K, Anderson S, Tack R, Taggard D, Lennarson P, Menhusen
M, Gelb A, Lownie S, Craen R, Novick T, Ferguson G, Duggal N, Findlay J, Ng W,
Cowie D, Badner N, Herrick I, Smith H, Heard G, Peterson R, Howell J, Lindsey L,
Carriere L, von Lewinski M, Schaefer B, Bisnaire D, Doyle-Pettypiece P, McTaggart
M, Giannotta S, Zelman V, Thomson E, Babayan E, McCleary C, Fishback D, Samra S,
Thompson B, Chandler W, Mcgillicuddy J, Tremper K, Turner C, Smythe P, Dy E, Pai
S, Portman V, Palmisano J, Auer D, Quigley M, Giordani B, Freymuth A, Scott P,
Silbergleit R, Hickenbottom S, Litt L, Lawton M, Hannegan L, Gupta D, Bickler P,
Dodson B, Talke P, Rampil I, Chen B, Wright P, Mitchell J, Ryan S, Walker J,
Quinnine N, Applebury C, Myles P, Rosenfeld J, Hunt J, Wallace S, D'rso P, Thien
C, McMahon J, Wadanamby S, Siu K, Malham G, Laidlaw J, Salerno S, Alatakis S,
Madder H, Cairo S, Konstantatos A, Smart J, Lindholm D, Bain D, Machlin H,
Moloney J, Buckland M, Silvers A, Downey G, Molnar A, Langley M, McIlroy D, Daly
D, Bennett P, Forlano L, Testa R, Burnett W, Johnson F, Angliss M, Fletcher H,
Manninen P, Wallace M, Lukitto K, Tymianski M, Porter P, Gentili F, El-Beheiry H,
Mosa M, Mak P, Balki M, Shaikh S, Sawyer R, Quader K, Chelliah R, Berklayd P,
Merah N, Ghazali G, McAndrews M, Ridgley J, Odukoya O, Yantha S, Wilson J,
Petrozza P, Miller C, O'Brien K, Tong C, Olympio M, Reynolds J, Colonna D,
Glazier S, Nobles S, Hill D, Hulbert H, Jenkins W, Lanier W, Piepgras D, Wilson
R, Meyer F, Atkinson J, Link M, Weglinski M, Berge K, McGregor D, Trenerry M,
Smith G, Walkes J, Felmlee-Devine M, Van Aken H, Greiner C, Freise H, Brors H,
Hahnenkamp K, Monteiro de Oliveira N, Schul C, Moskopp D, Woelfer J, Hoenemann C,
Gramke H, Bone H, Gibmeier I, Wirtz S, Lohmann H, Freyhoff J, Bauer B, Hogan K,
Dempsey R, Rusy D, Badie B, Iskandar B, Resnick D, Deshmukh P, Fitzpatrick J,
Sasse F, Broderick T, Willmann K, Connery L, Kish J, Weasler C, Page N, Hermann
B, Jones J, Dulli D, Stanko H, Geraghty M, Elbe R, Salevsky F, Leblanc R,
Lapointe N, Macgregor H, Sinclair D, Sirhan D, Maleki M, Abou-Madi M, Chartrand
D, Angle M, Milovan D, Painchaud Y, Mirski M, Tamargo R, Rice S, Olivi A, Kim D,
Rigamonti D, Naff N, Hemstreet M, Berkow L, Chery P, Ulatowski J, Moore L,
Cunningham T, McBee N, Hartman T, Heidler J, Hillis A, Tuffiash E, Chase C, Kane
A, Greene-Chandos D, Torbey M, Ziai W, Lane K, Bhardwaj A, Subhas N, Schubert A,
Mayberg M, Beven M, Rasmussen P, Woo J, Bhatia S, Ebrahim Z, Lotto M, Vasarhelyi
F, Munis J, Graves K, Woletz J, Chelune G, Samples S, Evans J, Blair D,
Abou-Chebl A, Shutway F, Manke D, Beven C, Fogarty-Mack P, Stieg P, Eliazo R, Li
P, Riina H, Lien C, Ravdin L, Wang J, Kuo Y, Jaffe R, Steinberg G, Luu D, Chang
S, Giffard R, Lemmens H, Morgan R, Mathur A, Angst M, Meyer A, Yi H, Karzmark P,
Bell-Stephens T, Marcellus M, Sneyd J, Pobereskin L, Salsbury S, Whitfield P,
Sawyer R, Dashfield A, Struthers R, Davies P, Rushton A, Petty V, Harding S,
Richardson S, Yonas H, Gyulai F, Kirby L, Kassam A, Bircher N, Meng L, Krugh J,
Seever G, Hendrickson R, Gebel J, Cowie D, Fabinyi G, Poustie S, Davis G, Drnda
A, Chandrasekara D, Sturm J, Phan T, Shelton A, Clausen M, Micallef S, Sills A,
Steinman F, Sutton P, Sanders J, Van Alstine D, Leggett D, Cunningham E, Hamm W,
Frankel B, Sorenson J, Atkins L, Redmond A, Dalrymple S, Black S, Fisher W, Hall
C, Wilhite D, Moore T 2nd, Blanton P, Sha Z, Szmuk P, Kim D, Ashtari A, Hagberg
C, Matuszczak M, Shahen A, Moise O, Novy D, Govindaraj R, Jameson L, Breeze R,
Awad I, Mattison R, Anderson T, Salvia L, Mosier M, Loftus C, Smith J, Lilley W,
White B, Lenaerts M.
Affiliation(s): Department of Anesthesia, University of Iowa, Iowa City, Iowa, USA.
brad-hindman@uiowa.edu
Publication date & source: 2010, Anesthesiology. , 112(1):86-101
BACKGROUND: Although hypothermia and barbiturates improve neurologic outcomes in
animal temporary focal ischemia models, the clinical efficacy of these
interventions during temporary occlusion of the cerebral vasculature during
intracranial aneurysm surgery (temporary clipping) is not established.
METHODS: A post hoc analysis of patients from the Intraoperative Hypothermia for
Aneurysm Surgery Trial who underwent temporary clipping was performed. Univariate
and multivariate logistic regression methods were used to test for associations
between hypothermia, supplemental protective drug, and short- (24-h) and
long-term (3-month) neurologic outcomes. An odds ratio more than 1 denotes better
outcome.
RESULTS: Patients undergoing temporary clipping (n = 441) were assigned to
intraoperative hypothermia (33.3 degrees +/- 0.8 degrees C, n = 208) or
normothermia (36.7 degrees +/- 0.5 degrees C, n = 233), with 178 patients also
receiving supplemental protective drug (thiopental or etomidate) during temporary
clipping. Three months after surgery, 278 patients (63%) had good outcome
(Glasgow Outcome Score = 1). Neither hypothermia (P = 0.847; odds ratio = 1.043,
95% CI = 0.678-1.606) nor supplemental protective drug (P = 0.835; odds ratio =
1.048, 95% CI = 0.674-1.631) were associated with 3-month Glasgow Outcome Score.
The effect of supplemental protective drug did not significantly vary with
temperature. The effects of hypothermia and protective drug did not significantly
vary with temporary clip duration. Similar findings were made for 24-h neurologic
status and 3-month Neuropsychological Composite Score.
CONCLUSION: In the Intraoperative Hypothermia for Aneurysm Surgery Trial, neither
systemic hypothermia nor supplemental protective drug affected short- or
long-term neurologic outcomes of patients undergoing temporary clipping.
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