Effect of Hypothermia Therapy on Children with Traumatic Brain Injury: A Meta-Analysis of Randomized Controlled Trials

Abstract

Hypothermia therapy is a promising therapeutic strategy for traumatic brain injury (TBI); however, some trials have shown that hypothermia therapy has a negative effect on patients with TBI. The treatment of hypothermia in children with TBI remains controversial. We conducted a search of six online databases to validate the literature on comparing hypothermia with normal therapy for children with TBI. Eight randomized controlled trials (514 patients) were included. The meta-analysis indicated that hypothermia therapy may increase the Glasgow Outcome Scale (GOS) scores. However, in terms of improving the rate of complications, intracranial pressure (ICP), mortality, cerebral perfusion pressure (CPP), and length of stay both in hospital as well as pediatric ICU, the difference was not statistically significant. Hypothermia therapy may have clinical advantages in improving the GOS scores in children with TBI compared with normothermic therapy, but hypothermia therapy may have no benefit in improving the incidence of complications, ICP, mortality, CPP, and length of stay both in pediatric ICU as well as hospital. The decision to implement hypothermia therapy for children with TBI depends on the advantages and disadvantages from many aspects and these must be considered comprehensively.

Role of Therapeutic Hypothermia in Improving Outcome After Traumatic Brain Injury : A Systematic Review

“…Nevertheless, a recent meta-analysis indicates that HT may be associated with increased mortality rates and unfavorable outcomes in trials of high methodological quality. 12,13 The current study unveiled the presence role of therapeutic hypothermia in improving outcome after traumatic brain injury.…”

“…4 Primary injury is an injury resulting from mechanical trauma in the form of a physical impact to the head which results in compression and injury to adjacent tissues either with or without loss of consciousness. 3,13,17,19 The surrounding brain cells will be functionally impaired, but not dead and if conditions are favorable the cells will recover within minutes, hours or days. The subsequent stage is referred to as the secondary pathogenic process.…”

“…Furthermore, a multicenter trial with a substantial sample size has provided evidence suggesting that HT could potentially have a negative effect on both mortality rates and functional outcomes. [11][12][13] This observation indicates that the use of hypothermia as a therapeutic technique in patients with TBI continues to be a topic of debate and disagreement within the academic community. Systematic reviews may also present divergent findings.…”

Temperature Control in Acute Brain Injury: An Update

“…187 Subsequent meta-analyses focused on clinical trials revealed a significant increase of 73 and 87% in the mortality risk among children with TBI treated with HTC. 99,[188][189][190] Despite successful preclinical studies and established concepts for neuroprotection in animal models of acute brain injury, the challenge remains in effectively translating these findings into clinical therapies, given the presence of varying outcomes in terms of efficacy across pediatric clinical trials. Although HTC is not a universal intervention for every form of acute brain injury, the proactive prevention of hyperthermia is deemed a safe approach for managing critically ill children who have confirmed or suspected neurological injuries.…”

Approaches to neuroprotection in pediatric neurocritical care

“…Of greater debate is whether the practice of induced hypothermia (typically within the range of 32-35 °C) improves neurologic outcomes in selected pediatric populations. A recent meta-analysis of eight randomized controlled trials assessing therapeutic hypothermia in pediatric severe TBI found a non-statistically significant trend towards increased mortality in patients who were treated with therapeutic hypothermia compared to normothermic controls[ 49 ]. In post-arrest care, two large, multicenter, randomized controlled trials have been conducted to assess the benefit of therapeutic hypothermia after cardiac arrest in children separately evaluating comatose children after in-hospital (THAPCA-IH) and out-of-hospital (THAPCA-OH) arrests.…”