Cooling system may have neuroprotective effects in acute stroke


A poster presented at the European Stroke Conference (6–9 May 2014, Nice, France) by Robbert-Jan van Hooff (Department of Neurology, Universitair Ziekenhuis Brussel, Brussels, Belgium) and colleagues reports that surface cooling of the neck with a surface cooling system could contribute to therapeutic hypothermia and neuroprotective effects in acute stroke.

In the pilot study COOL (Effects of surface cooling on stroke outcome trial) included 20 healthy volunteers in whom surface cooling was induced using the  Brain.Pad (Emcools) to noninvasively and mildly lower brain temperature.

Surface cooling was initiated through application of the cooling system for 60 minutes. Tolerance of cooling was assessed by the Bedside Shivering Assessment Scale (BSAS) every 15 minutes alongside a side-effects checklist.

Cerebral blood flow, according to the authors, was continually monitored with transcranial Doppler. Efficacy was evaluated by measuring temperature at the inguinal, mastoid, tympanic and temporal locations.

In the 20 volunteers (eight male, 12 female; mean±SD age=32.3±11.9 years), a significant decrease of tympanic and temporal temperature was observed at the end of cooling (36.5 vs. 36.1°C and 37.1 vs. 36.7°C, respectively; p<0.001). At 60 minutes the maximum mean BSAS score was 0.6.

Van Hooff et al note that, apart from increased blood pressure five minutes post-application compared to baseline (systolic blood pressure 138 vs. 118mmHg; diastolic 81 vs. 66mmHg; both p<0.0001) there was no impact on vital parameters or cerebral blood flow.

“In healthy volunteers, surface cooling of the neck with Emcools Brain.Pad is feasible, well tolerated and does not influence cerebral blood flow. Confirmation is needed in acute stroke patients,” the authors conclude.