Mild induced hypothermia for patients with severe traumatic brain injury after decompressive craniectomy

Tang, Chunhai; Bao, Yun; Qi, Min; Zhou, Lizhi; Liu, Fan; Mao, Jian; Lei, Qingmei; Qi, Songtao; Qiu, Binghui

doi:10.1016/j.jcrc.2016.12.012

Cited by 22 publications

(29 citation statements)

References 16 publications

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“…Our findings are in line with several clinical trials showing a beneficial effect of therapeutic hypothermia on the outcome of severe TBI, 13,14,17,21,23,25,26,[29][30][31] whereas they 14 Journal of Neurotrauma Therapeutic whole-body hypothermia reduces mortality in severe traumatic brain injury if the cooling index is sufficiently high: meta-analyses of the effect of single cooling parameters and their integrated measure (DOI: 10.1089/neu.2018.5649) This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction. The final published version may differ from this proof.…”

Section: Discussionsupporting

confidence: 91%

“…Only those studies were included in the meta-analyses, in which the effect of therapeutic hypothermia was compared with no cooling interventions on the mortality ratio of adult patients with severe TBI. Nineteen RCTs 13,14,16,18,[20][21][22][23][24][25][26][27][28][29][30][31][44][45][46] and eight articles 15,17,19,34,[47][48][49][50] of other study types were eligible for meta-analysis. The relevant data were extracted from these studies by two investigators (EO and AG) independently into Microsoft Excel software (Microsoft Corporation, Redmond, WA, USA).…”

Section: Data Extractionmentioning

confidence: 99%

“…In five of the analyzed studies, 14,25,26,29,31 the cooling protocol was changed depending from the ICP. Thus, we also compared whether the outcome of TBI differed between the group of studies which reported adjustments in the cooling protocol based on ICP and the group of studies which did not.…”

Section: Journal Of Neurotraumamentioning

confidence: 99%

“…13 Over the last 25 years, numerous clinical trials have been conducted to assess the effects of induced hypothermia in severe TBI. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31] Cooling of patients with severe TBI improved the outcome in several of these studies, 14,17,5 Journal of Neurotrauma Therapeutic whole-body hypothermia reduces mortality in severe traumatic brain injury if the cooling index is sufficiently high: meta-analyses of the effect of single cooling parameters and their integrated measure (DOI: 10.1089(DOI: 10. /neu.2018 This paper has been peer-reviewed and accepted for publication, but has yet to undergo copyediting and proof correction.…”

Section: Introductionmentioning

confidence: 99%

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Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure

Oláh

Pótó

Hegyi

et al. 2018

Journal of Neurotrauma

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Therapeutic hypothermia was investigated repeatedly as a tool to improve the outcome of severe traumatic brain injury (TBI), but previous clinical trials and meta-analyses found contradictory results. We aimed to determine the effectiveness of therapeutic whole-body hypothermia on the deaths of adult patients with severe TBI by using a novel approach of meta-analysis. We searched the PubMed, EMBASE, and Cochrane Library databases from inception to February 2017. The identified human studies were evaluated regarding statistical, clinical, and methodological designs to ensure interstudy homogeneity. We extracted data on TBI severity, body temperature, death, and cooling parameters; then we calculated the cooling index, an integrated measure of therapeutic hypothermia. Forest plot of all identified studies showed no difference in the outcome of TBI between cooled and not cooled patients, but interstudy heterogeneity was high. On the contrary, by meta-analysis of randomized clinical trials that were homogenous with regard to statistical, clinical designs, and precisely reported the cooling protocol, we showed decreased odds ratio for death in therapeutic hypothermia compared with no cooling. As independent factors, milder and longer cooling, and rewarming at <0.25°C/h were associated with better outcome. Therapeutic hypothermia was beneficial only if the cooling index (measure of combination of cooling parameters) was sufficiently high. We conclude that high methodological and statistical interstudy heterogeneity could underlie the contradictory results obtained in previous studies. By analyzing methodologically homogenous studies, we show that cooling improves the outcome of severe TBI, and this beneficial effect depends on certain cooling parameters and on their integrated measure, the cooling index.

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Section: Discussionsupporting

confidence: 91%

Section: Data Extractionmentioning

confidence: 99%

Section: Journal Of Neurotraumamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure

Oláh

Pótó

Hegyi

et al. 2018

Journal of Neurotrauma

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“…Multiple studies and meta-analyses have reported benefit for prophylactic hypothermia as a potential neuroprotectant after traumatic brain injury. 7,8,[21][22][23][24][25][26][27][28][29][30][31] Three higher-quality multicenter randomized trials of prophylactic hypothermia demonstrated no benefit, but these had methodological limitations and 2 stopped prematurely (≤50% projected sample size). [13][14][15] The most recent meta-analysis of prophylactic hypothermia after severe traumatic brain injury 8 suggested that early prophylactic hypothermia may be most beneficial when Data are presented as n/N (%) unless otherwise indicated and are presented for the intention-to-treat population.…”

Section: Discussionmentioning

confidence: 99%

Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury

Cooper

Nichol

Bailey

et al. 2018

JAMA

258

167

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IMPORTANCE After severe traumatic brain injury, induction of prophylactic hypothermia has been suggested to be neuroprotective and improve long-term neurologic outcomes. OBJECTIVE To determine the effectiveness of early prophylactic hypothermia compared with normothermic management of patients after severe traumatic brain injury. DESIGN, SETTING, AND PARTICIPANTS The Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury-Randomized Clinical Trial (POLAR-RCT) was a multicenter randomized trial in 6 countries that recruited 511 patients both out-of-hospital and in emergency departments after severe traumatic brain injury. The first patient was enrolled on December 5, 2010, and the last on November 10, 2017. The final date of follow-up was May 15, 2018. INTERVENTIONS There were 266 patients randomized to the prophylactic hypothermia group and 245 to normothermic management. Prophylactic hypothermia targeted the early induction of hypothermia (33°C-35°C) for at least 72 hours and up to 7 days if intracranial pressures were elevated, followed by gradual rewarming. Normothermia targeted 37°C, using surface-cooling wraps when required. Temperature was managed in both groups for 7 days. All other care was at the discretion of the treating physician. MAIN OUTCOMES AND MEASURES The primary outcome was favorable neurologic outcomes or independent living (Glasgow Outcome Scale-Extended score, 5-8 [scale range, 1-8]) obtained by blinded assessors 6 months after injury. RESULTS Among 511 patients who were randomized, 500 provided ongoing consent (mean age, 34.5 years [SD, 13.4]; 402 men [80.2%]) and 466 completed the primary outcome evaluation. Hypothermia was initiated rapidly after injury (median, 1.8 hours [IQR, 1.0-2.7 hours]) and rewarming occurred slowly (median, 22.5 hours [IQR, 16-27 hours]). Favorable outcomes (Glasgow Outcome Scale-Extended score, 5-8) at 6 months occurred in 117 patients (48.8%) in the hypothermia group and 111 (49.1%) in the normothermia group (risk difference, 0.4% [95% CI,-9.4% to 8.7%]; relative risk with hypothermia, 0.99 [95% CI, 0.82-1.19]; P = .94). In the hypothermia and normothermia groups, the rates of pneumonia were 55.0% vs 51.3%, respectively, and rates of increased intracranial bleeding were 18.1% vs 15.4%, respectively. CONCLUSIONS AND RELEVANCE Among patients with severe traumatic brain injury, early prophylactic hypothermia compared with normothermia did not improve neurologic outcomes at 6 months. These findings do not support the use of early prophylactic hypothermia for patients with severe traumatic brain injury.

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Hypothermia for traumatic brain injury

Lewis

Evans

Butler

et al. 2017

Cochrane Database of Systematic Reviews

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Mild induced hypothermia for patients with severe traumatic brain injury after decompressive craniectomy

Cited by 22 publications

References 16 publications

Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure

Therapeutic Whole-Body Hypothermia Reduces Death in Severe Traumatic Brain Injury if the Cooling Index Is Sufficiently High: Meta-Analyses of the Effect of Single Cooling Parameters and Their Integrated Measure

Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain Injury

Hypothermia for traumatic brain injury

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