Hypothermia in the management of traumatic brain injury: A systematic review and meta-analysis

• Published in: Intensive care medicine Vol. 29; no. 10; pp. 1637 - 1644
• Main Authors: HENDERSON, William R, DHINGRA, Vinay K, CHITTOCK, Dean R, FENWICK, John C, RONCO, Juan J
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer 01.10.2003; Berlin Springer Nature B.V
• Subjects: Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Brain Injuries - therapy; Critical care; Emergency and intensive care: comas and nervous system diseases; Head injuries; Health sciences; Hospitals; Humans; Hyperventilation; Hypothermia; Hypothermia, Induced; Iatrogenesis; Intensive care; Intensive care medicine; Intracranial pressure; Medical sciences; Medicine; Mortality; Pneumonia; Randomized Controlled Trials as Topic; Trauma; Traumatic brain injury; North America; Europe; Human; Lung disease; Nervous system diseases; Pneumonia; Intensive care; Prognosis; Respiratory disease; Mortality; Diseases of the osteoarticular system; General anesthesia; Controlled therapeutic trial; Induced hypothermia; Neuroprotective agent; Cerebral disorder; Metaanalysis; Controlled trial; Randomization; Treatment; Central nervous system disease; Skull disease; Head trauma; Brain injury; Hypothermia
• ISSN: 0342-4642; 1432-1238
• DOI: 10.1007/s00134-003-1848-2

Brain injury remains the leading cause of death in cases of trauma in North America and Europe. This article critically appraised and summarised all published and peer-reviewed, randomised, controlled trials of the use of hypothermia in traumatic brain injury. To be included, a study had to be a published, randomised, controlled trial of the use of hypothermia in the management of traumatic brain injury. Pooling of data and meta-analysis of results occurred. Conducted at a tertiary level Canadian teaching hospital. Patients were combined from eight randomised, controlled trials to generate a population of 748 severely head-injured patients. Eight studies provided data on the efficacy of hypothermia in the management of traumatic brain injury. The pooled odds ratio of mortality in the hypothermic group was 0.81 (95%CI =0.59-1.13, p=0.22). The OR of a poor neurological outcome (GOS 1,2 or 3) was 0.75 (95% CI=0.56-1.01, p=0.06). The odds ratio for pneumonia in the normothermic group was 0.42 (95%CI =0.25-0.70, p=0.001). Although meta-analysis suggests that iatrogenic hypothermia may confer a marginal benefit in neurological outcome, there does not appear to be clear evidence of lower mortality rates in unselected traumatic brain injury patients. Prolonged hypothermia may confer a benefit, particularly in patients with elevated intracranial pressure refractory to conventional manipulations. Conclusions regarding the use of hypothermia are controversial and not strongly supported by the available evidence.