Intracranial Pressure Increases during Rewarming Period after Mild Therapeutic Hypothermia in Postcardiac Arrest Patients

Hiromichi Naito, Eiji Isotani, Clifton W. Callaway, Shingo Hagioka, Naoki Morimoto

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)


Elevation of intracranial pressure (ICP) may worsen brain injury and neurological outcome. Studies on the use of therapeutic hypothermia (TH) for traumatic brain injury suggests that rapid rewarming from TH is associated with elevated ICP and poorer outcomes. However, few studies describe the time course of ICP changes during TH/rewarming after cardiac arrest (CA). In this study, we observed the changes in ICP during mild TH and rewarming after CA. Secondarily, we examined whether ICP is related to outcome. We studied comatose patients resuscitated from CA, who were treated with TH and who had ICP monitored. Target core temperature was 34°C for 24 h and target rewarming rate was 0.25°C/h. ICP and cerebral perfusion pressure (CPP) were monitored during the period. Outcome was rated as cerebral performance category. In nine patients, ICP increased during TH and rewarming (6.0 [4.0-9.0] mmHg to 16.0 [12.0-26.0] mmHg, p = 0.008). CPP did not change during the period (83.3 [80.1-91.0] mmHg to 74.3 [52.0-87.3] mmHg). Higher ICP was associated with worse outcomes (p = 0.009). All the cases with ICP >25 mmHg or CPP <40 mmHg died. Major ICP increment was observed during the rewarming period, although, some increase of ICP occurred even during the mild TH. ICP increment was higher in patients with worse outcomes.

Original languageEnglish
Pages (from-to)189-193
Number of pages5
JournalTherapeutic Hypothermia and Temperature Management
Issue number4
Publication statusPublished - Dec 1 2016
Externally publishedYes


  • Intracranial pressure
  • cerebral edema
  • heart arrest

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine


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