A Cochrane review [Abstract] 1 included 8 studies with a total of 423 subjects. Five were harmacological temperature reduction trials and 3 physical cooling trials. The patients had acute ischaemic stroke or intracerebral haemorrhage. Pharmacological cooling was done by paracetamol, ibuprofen or metamizole (3 studies were double-blind). Physical cooling was done by surface cooling, cooling blanket, ice water, whole-body ice rubs or endovascular cooling (studies were not blinded). All studies were designed to test safety and feasibility, and allowed rather long time periods between stroke onset and start of treatment. Follow-up time was one month for pharmacological trials and 1-6 months for physical cooling trials. There was no significant effect of pharmacological or physical temperature-lowering therapy in reducing the risk of death or dependency (OR 0.9, 95% CI 0.6 to 1.4) or death (OR 0.9, 95% CI 0.5 to 1.5) at the final follow-up. Both interventions were associated with a non-significant increase in the occurrence of infections (OR 1.5, 95% CI 0.8 to 2.6).
Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in populations and interventions), imprecise results (few patients and wide confidence intervals) and indirectness (long time periods between stroke onset and start of treatment).
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