Endovascular Cooling for Severe Hyperthermia in Cervical Spine Injury

Abstract

Sustained severe hyperthermia in patients with high cervical spinal cord injuries may have many etiologies, from infection to autonomic dysregulation. When uncontrolled, it has been seen to have a high morbidity and mortality. We present two patients with high cervical spinal cord injury (SCI) who had sustained severe hyperpyrexia, of possible autonomic origin. The temperature stayed above 40°C and was uncontrolled with conventional methods of temperature management. We employed endovascular cooling for therapeutic normothermia which was successful in effective control of temperature in both the patients. The first patient suffered complications from deep vein thrombosis and pulmonary embolism which may be attributed to the presence of the cooling catheter in spite of chemical and mechanical thromboprophylaxis. The use of endovascular cooling in the management of severe life threatening hyperthermia in patients with cervical SCI may be an useful intervention. There must be a high suspicion for the possibility of deep vein thrombosis in this subgroup, however.