Increased risk of deep venous thrombosis with endovascular cooling in patients with traumatic head injury

Endovascular therapeutic hypothermia has been shown to preserve neurological function and improve outcomes; however, its use and potential complications have not been fully described in patients with traumatic head injuries. We believe that the use of endovascular cooling leads to deep venous thrombosis (DVT) in this high-risk population. We performed a retrospective review of 11 patients with severe head injuries admitted to our Level I trauma center surgical intensive care unit who underwent intravascular cooling. Duplex sonograms were obtained after 4 days at catheter removal or with clinical symptoms that were suspicious for DVT. Patients had a mean age of 23.2 (range, 16-42) years and an Injury Severity Score of 31.9 (range, 25-43). The overall incidence of DVT was 50 per cent. The DVT rate was 33 per cent if catheters were removed in 4 days or less and 75 per cent if removed after 4 days (risk ratio = 2.25; odds ratio = 6; P = ns). An elevated international normalized ratio upon admission was protective against DVT (no DVT = 1.26 vs DVT = 1.09; P = 0.02). Inferior vena cava filters were placed in most patients with DVT. The use of endovascular cooling catheters is associated with increased risk of DVT in patients with traumatic head injuries. Therefore, we discourage the use of endovascular cooling devices in this patient population.