Hypothermia for Neuroprotection in Convulsive Status Epilepticus
Stephane Legriel, Virginie Lemiale, Maleka Schenck, Jonathan Chelly, Virginie Laurent, Fabrice Daviaud, Mohamed Srairi, Aicha Hamdi, Guillaume Geri, Thomas Rossignol, Julia Hilly-Ginoux, Julie Boisramé-Helms, Benjamin Louart, Isabelle Malissin, Nicolas Mongardon, Benjamin Planquette, Marina Thirion, Sybille Merceron, Emmanuel Canet, Fernando Pico, Yves-Roger Tran-Dinh, Jean-Pierre Bedos, Elie Azoulay, Matthieu Resche-Rigon, Alain Cariou, HYBERNATUS Study Group, J Lejeune, B Vivien, G Jacq, J Bedel, P Cronier, M Henry-Lagarrigue, A Gros, N Zappella, A Ferre, C Simon, P Guezennec, F Bruneel, B Zuber, G Lacave, G Troche, J D Moyer, D Grimaldi, O Richard, N Deye, S Rigaudeau, B Crepon, H Mentec, T Geeraerts, D Schnell, R Neagu, F Meziani, J E Herbrecht, J Y Lefrant, C Vinsonneau, S Cavelot, P Vauboin, L Mameri, N Marin, T de Broucker, A Combes, N Pichon, P Jabre, Stephane Legriel, Virginie Lemiale, Maleka Schenck, Jonathan Chelly, Virginie Laurent, Fabrice Daviaud, Mohamed Srairi, Aicha Hamdi, Guillaume Geri, Thomas Rossignol, Julia Hilly-Ginoux, Julie Boisramé-Helms, Benjamin Louart, Isabelle Malissin, Nicolas Mongardon, Benjamin Planquette, Marina Thirion, Sybille Merceron, Emmanuel Canet, Fernando Pico, Yves-Roger Tran-Dinh, Jean-Pierre Bedos, Elie Azoulay, Matthieu Resche-Rigon, Alain Cariou, HYBERNATUS Study Group, J Lejeune, B Vivien, G Jacq, J Bedel, P Cronier, M Henry-Lagarrigue, A Gros, N Zappella, A Ferre, C Simon, P Guezennec, F Bruneel, B Zuber, G Lacave, G Troche, J D Moyer, D Grimaldi, O Richard, N Deye, S Rigaudeau, B Crepon, H Mentec, T Geeraerts, D Schnell, R Neagu, F Meziani, J E Herbrecht, J Y Lefrant, C Vinsonneau, S Cavelot, P Vauboin, L Mameri, N Marin, T de Broucker, A Combes, N Pichon, P Jabre
Abstract
Background: Convulsive status epilepticus often results in permanent neurologic impairment. We evaluated the effect of induced hypothermia on neurologic outcomes in patients with convulsive status epilepticus.
Methods: In a multicenter trial, we randomly assigned 270 critically ill patients with convulsive status epilepticus who were receiving mechanical ventilation to hypothermia (32 to 34°C for 24 hours) in addition to standard care or to standard care alone; 268 patients were included in the analysis. The primary outcome was a good functional outcome at 90 days, defined as a Glasgow Outcome Scale (GOS) score of 5 (range, 1 to 5, with 1 representing death and 5 representing no or minimal neurologic deficit). The main secondary outcomes were mortality at 90 days, progression to electroencephalographically (EEG) confirmed status epilepticus, refractory status epilepticus on day 1, "super-refractory" status epilepticus (resistant to general anesthesia), and functional sequelae on day 90.
Results: A GOS score of 5 occurred in 67 of 138 patients (49%) in the hypothermia group and in 56 of 130 (43%) in the control group (adjusted common odds ratio, 1.22; 95% confidence interval [CI], 0.75 to 1.99; P=0.43). The rate of progression to EEG-confirmed status epilepticus on the first day was lower in the hypothermia group than in the control group (11% vs. 22%; odds ratio, 0.40; 95% CI, 0.20 to 0.79; P=0.009), but there were no significant differences between groups in the other secondary outcomes. Adverse events were more frequent in the hypothermia group than in the control group.
Conclusions: In this trial, induced hypothermia added to standard care was not associated with significantly better 90-day outcomes than standard care alone in patients with convulsive status epilepticus. (Funded by the French Ministry of Health; HYBERNATUS ClinicalTrials.gov number, NCT01359332 .).
Source: PubMed