MSc BLOG – Cooling therapies & stroke

May 22, 2018

Cooling in acute stroke management: MSc in EBHC dissertation

My dissertation explores the use of cooling therapies in acute stroke. A stroke occurs due to a lack of a blood supply to the brain either by a blood clot or a haemorrhage. Currently there are limited, time-specific options available to treat patients with a stroke, and therefore most stroke patients are ineligible for treatments that aim to prevent disability and death.

Strokes are disabling and account for the majority of complex disability in the UK and are the second most common cause of mortality. There is an intense emotional and physical burden associated with a stroke with many people being unable to work, and friends and family providing long-term care and financial support. ‘Cooling’ or reducing core body temperature has been shown to protect the brain during times of stress such as a period of low blood supply and is routinely used in cardiac surgery and after cardiac arrest.

What did we do?
My dissertation explored whether cooling using medications or by applying cooling pads or cooling catheters could be helpful in an acute stroke. There were several trials in the area that had explored cooling, including several large trials that had been recently completed.

As a trainee stroke physician I thought this would be an interesting area to explore – to see if cooling had a benefit in strokes or whether our resources would be better focused in a different area. To address this question I conducted systematic review and meta-analysis.

What did we find?
I found that cooling core body temperature does not improve disability or mortality in an acute stroke. I also found there was a trend towards higher rates of complications such as infections and arrhythmias.

What do these results mean?
Although cooling is not in widespread use in Europe and the UK, the dissertation has opened a debate of whether trials in this area are necessary or whether funding should be focused in other areas of stroke care. The findings are being presented at an international stroke conference and I am preparing the dissertation for submission to a stroke journal.

Overall I found the dissertation and Masters course a rewarding experience that pushed my research skills and writing ability. I realised that a lot can be accomplished independently over a short time period and you really can find useful and practice changing outcomes by the end of the degree.

Dr Abid Malik
I am a specialist registrar (ST6) in Geriatric, General internal and Stroke medicine. I recently completed the MSc in Evidence-based Health Care and currently work in Charing Cross hospital in London where I am completing my training fellowship in Stroke medicine.

Current affiliation: North West London deanery; Charing Cross hospital

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