To examine the impact of early decompressive hemicraniectomy (DHC) combined with mild hypothermia (MH) on mortality and clinical outcomes, specifically focusing on 30-day all-cause mortality and 6-month mRS scores, in patients with malignant middle cerebral artery (MCA) infarction.
Key Findings:
DHC + MH group showed better 6-month mRS scores (P = 0.025) and lower 30-day all-cause mortality (17.6% vs. 29.7%, P = 0.04).
Higher rates of complications such as shivering (46.2% vs. 6.6%, P < 0.001), bradycardia (68.1% vs. 38.5%, P < 0.001), electrolyte disturbance (65.5% vs. 38.5%, P = 0.002), and acidosis (35.5% vs. 18.7%, P = 0.008) were observed in the DHC + MH group.
No significant differences in delayed intracranial hematomas, pneumonia, acute kidney injury, or coagulation disorders between the two groups.
Interpretation:
The findings suggest that combining mild hypothermia with decompressive hemicraniectomy may improve clinical outcomes in patients with malignant MCA infarction, although the increased risk of complications, such as shivering and bradycardia, must be carefully considered.
Limitations:
Non-randomized allocation may introduce bias, and potential confounding factors, such as age and comorbidities, were not adjusted for in the analysis.
Results require validation through larger, multicenter, prospective, randomized controlled trials.
Conclusion:
Mild hypothermia during decompressive hemicraniectomy appears to be associated with favorable outcomes, but further research is needed to confirm these findings and address the associated risks.
