Feasibility and safety of High-quality targeted temperature management in poor-grade aneurysmal subarachnoid hemorrhage: a multicenter prospective study with propensity-score matching.

This multicenter prospective study aimed to evaluate the feasibility and safety of high-quality targeted temperature management (TTM) in patients with poor-grade aneurysmal subarachnoid hemorrhage (aSAH). A prospective parallel-controlled clinical trial was conducted across three hospitals in China. Patients with poor-grade aSAH were enrolled between April 2022 and April 2024. Eligible patients with poor-grade aSAH (Hunt-Hess grade IV-V) were divided into TTM (n = 45) and normothermia (n = 45) groups after 1:1 propensity score matching (PSM) with nearest neighbor using age, gender, disease severity, comorbidities, and surgical variables. The TTM protocol involved initial 36-37℃, cooling to 34℃ post-aneurysm repair, hypothermia lasted for 3-5 days, followed by gradual rewarming with 0.1-0.25 °C/hour and normothermia maintenance. The TTM device used a temperature feedback system and a medical wrapped ice blanket. Primary outcomes included 3-month favorable functional prognosis [modified Rankin Scale (mRS) 0-3], with secondary outcomes assessing mortality, complications, and hospitalization metrics. Statistical analyses employed multivariable logistic regression and subgroup analyses to adjust for confounders. Among 124 enrolled patients, 90 (72.6%) were matched. The TTM group had a significantly higher rate of favorable outcomes (42.2% vs. 22.2%, P = 0.042) and improved neurological recovery (median GCS at discharge: 7.0 vs. 5.0, P = 0.048). A non-significant reduction in mortality was observed in the TTM group (20.0% vs. 31.1%, P = 0.227). TTM reduced DCI incidence (31.1% vs. 48.9%, P = 0.085) and demonstrated a comparable safety profile for systemic complications (e.g., pneumonia: 53.3% vs. 66.7%; cardiovascular events: 22.2-35.6%). However, TTM required prolonged hospitalization (median: 21 vs. 15 days, P = 0.030) and ICU stays (19 vs. 14 days, P = 0.075). Subgroup analyses revealed consistent benefits across age, severity, and surgical subgroups. In this exploratory study, high-quality TTM improved functional outcome and was associated with a non-significant reduction in DCI risk in poor-grade aSAH patients without increasing adverse events, though prolonged hospitalization was observed.These hypothesis-generating findings need further investigation through multicenter randomized trials to optimize TTM protocols and validate long-term benefits.