Hypothermia Did Not Improve Outcomes After Traumatic Brain Injury

Prof. Peter JD Andrews Honorary Professor Department of Anaesthesia University of EdinburghMedicalResearch.com Interview with:
Prof. Peter JD Andrews
Honorary Professor
Department of Anaesthesia
University of Edinburgh 

Medical Research: What is the background for this study?

Prof. Andrews: Therapeutic hypothermia has shown considerable promise as a neuro-protective intervention in many species and models of cerebral injury in the laboratory. Clinical trials after neonatal hypoxic ischemic encephalopathy and cardiac arrest (global cereal ischemia) show signal of benefit.
The outcome after traumatic brain injury (TBI) has not improved in the last 20 years. Clinical trials of prophylactic therapeutic hypothermia for neuroprotection after traumatic brain injury show a mixed outcome, however, the larger trials are all neutral or have a trend toward harm.

Because traumatic brain injury is a heterogeneous pathology it has been suggest that the therapeutic hypothermia intervention should be adjusted according to response of a biomarker, to maximize benefit and limit any harms. The EUROTHERM3235Trial was a trial of therapeutic hypothermia to reduce brain swelling after traumatic brain injury. Brain swelling was measured by an intracranial pressure (ICP) probe directly inserted into the brain.

Medical Research: What are the main findings?

Prof. Andrews: Hypothermia successfully reduced intracranial pressure, but did not improve outcomes compared to standard care alone, with more than a third achieving a good outcome in the standard care group and one a quarter in the hypothermia group.

Medical Research: What should clinicians and patients take away from your report?

Prof. Andrews: Clinicians should not use hypothermia to reduce intracranial pressure <20mmHg after traumatic brain injury, even if struggling to control ICP by standard means alone.

Medical Research: What recommendations do you have for future research as a result of this study?

Prof. Andrews: I recommend exploring the effect of strict normothermia after traumatic brain injury compared with no temperature control.


Hypothermia for Intracranial Hypertension after Traumatic Brain Injury

Peter J.D. Andrews, M.D., M.B., Ch.B., H. Louise Sinclair, R.G.N., M.Sc., Aryelly Rodriguez, M.Sc., Bridget A. Harris, R.G.N., Ph.D., Claire G. Battison, R.G.N., B.A., Jonathan K.J. Rhodes, Ph.D., M.B., Ch.B., and Gordon D. Murray, Ph.D. for the Eurotherm3235 Trial Collaborators

October 7, 2015DOI: 10.1056/NEJMoa1507581

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Prof. Peter JD Andrews (2015). Hypothermia Did Not Improve Outcomes After Traumatic Brain Injury