25 Oct No Benefit, More Complications with Hypothermia after Traumatic Brain Injury
MedicalResearch.com Interview with:
Jamie Cooper AO
BMBS MD FRACP FCICM FAHMS
Professor of Intensive Care Medicine
Deputy Director & Head of Research,
Intensive Care & Hyperbaric Medicine
The Alfred, Melbourne
MedicalResearch.com: What is the background for this study?
Response: 50-60 million people each year suffer a traumatic brain injury (TBI) . When the injury is severe only one half are able to live independently afterwards.
Cooling the brain (hypothermia) is often used in intensive care units for decades to decrease inflammation and brain swelling and hopefully to improve outcomes, but clinical staff have had uncertainty whether benefits outweigh complications.
We conducted the largest randomised trial of hypothermia in TBI, in 500 patients, in 6 countries, called POLAR. We started cooling by ambulance staff, to give hypothermia the best chance to benefit patients. We continued for 3-7 days in hospital ind ICU. We measured functional outcomes at 6 months.
MedicalResearch.com: What are the main findings?
Response: We found that carefully measured outcomes after severe TBI were exactly the same at 49% independent outcomes in both study groups. Remarkably, hypothermia had no measurable effect on patients functional outcome at all. Hypothermia did however increase complications of low blood pressure, and pneumonia.
MedicalResearch.com: What should readers take away from your report?
Response: Even when hypothermia is used in such a way as to maximinse benefits and decrease complications, it does not benefit patients after a severe TBI. It also requires expensive cooling devices, longer intensive care time and increases complications.
The best target temperature for trauma patients during the week after severe TBI is now the normal one, not the cool one. Clinical guidelines should be adjusted accordingly
POLAR was funded by the Australian government through the NHMRC, and also the Victorian State Government via the TAC. No other relevant disclosures. No industry support. POLAR was managed by the ANZIC Research Centre at Monash University, Melbourne Australia, and endorsed by the ANZICS Clinical Trials Group.
Cooper DJ, Nichol AD, Bailey M, et al. Effect of Early Sustained Prophylactic Hypothermia on Neurologic Outcomes Among Patients With Severe Traumatic Brain InjuryThe POLAR Randomized Clinical Trial. JAMA.Published online October 24, 2018. doi:10.1001/jama.2018.17075
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