Hypothermia for severe traumatic brain injury in adults: Recent lessons from randomized controlled trials

Shahzad Shaefi, Aaron M. Mittel, Jonathan A. Hyam, M. Dustin Boone, Clark C. Chen, Ekkehard M. Kasper

Research output: Contribution to journalArticlepeer-review

10 Scopus citations

Abstract

Background: Traumatic brain injury (TBI) is a worldwide health concern associated with significant morbidity and mortality. In the United States, severe TBI is managed according to recommendations set forth in 2007 by the Brain Trauma Foundation (BTF), which were based on relatively low quality clinical trials. These guidelines prescribed the use of hypothermia for the management of TBI. Several randomized controlled trials (RCTs) of hypothermia for TBI have since been conducted. Despite this new literature, there is ongoing controversy surrounding the use of hypothermia for the management of severe TBI. Methods: We searched the PubMed database for all RCTs of hypothermia for TBI since 2007 with the intent to review the methodology outcomes of these trials. Furthermore, we aimed to develop evidence-based, expert opinions based on these recent studies. Results: We identified 8 RCTs of therapeutic hypothermia published since 2007 that focused on changes in neurologic outcomes or mortality in patients with severe TBI. The majority of these trials did not identify improvement with the use of hypothermia, though there were subgroups of patients that may have benefited from hypothermia. Differences in methodology prevented direct comparison between studies. Conclusions: A growing body of literature disfavors the use of hypothermia for the management of severe TBI. In general, empiric hypothermia for severe TBI should be avoided. However, based on the results of recent trials, there may be some patients, such as those in Asian centers or with focal neurologic injury, who may benefit from hypothermia.

Original languageEnglish (US)
Article number194816
JournalSurgical Neurology International
Volume7
Issue number1
DOIs
StatePublished - Jan 1 2016

Bibliographical note

Publisher Copyright:
© 2016 Surgical Neurology International | Published by Wolters Kluwer - Medknow.

Keywords

  • Critical care
  • TBI
  • expert opinion
  • hypothermia
  • traumatic brain injury

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