Research Reports - Therapeutic hypothermia for traumatic brain injury in adult and pediatric patients

Crit Care Med. 2017 Apr;45(4):575-583. doi: 10.1097/CCM.0000000000002205.

Crompton EM(1), Lubomirova I, Cotlarciuc I, Han TS, Sharma SD, Sharma P.

OBJECTIVE: Therapeutic hypothermia has been used to attenuate the effects of
traumatic brain injuries. However, the required degree of hypothermia, length of
its use, and its timing are uncertain. We undertook a comprehensive meta-analysis
to quantify benefits of hypothermia therapy for traumatic brain injuries in
adults and children by analyzing mortality rates, neurologic outcomes, and
adverse effects.
DATA SOURCES: Electronic databases PubMed, Google Scholar, Web of Science,
Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and manual
searches of studies were conducted for relevant publications up until February
2016.
STUDY SELECTION: Forty-one studies in adults (n = 3,109; age range, 18-81 yr) and
eight studies in children (n = 454; age range, 3 mo to 18 yr) met eligibility
criteria.
DATA EXTRACTION: Baseline patient characteristics, enrollment time, methodology
of cooling, target temperature, duration of hypothermia, and rewarming protocols
were extracted.
DATA SYNTHESIS: Risk ratios with 95% CIs were calculated. Compared with adults
who were kept normothermic, those who underwent therapeutic hypothermia were
associated with 18% reduction in mortality (risk ratio, 0.82; 95% CI, 0.70-0.96;
p = 0.01) and a 35% improvement in neurologic outcome (risk ratio, 1.35; 95% CI,
1.18-1.54; p < 0.00001). The optimal management strategy for adult patients
included cooling patients to a minimum of 33°C for 72 hours, followed by
spontaneous, natural rewarming. In contrast, adverse outcomes were observed in
children who underwent hypothermic treatment with a 66% increase in mortality
(risk ratio, 1.66; 95% CI, 1.06-2.59; p = 0.03) and a marginal deterioration of
neurologic outcome (risk ratio, 0.90; 95% CI, 0.80-1.01; p = 0.06).
CONCLUSIONS: Therapeutic hypothermia is likely a beneficial treatment following
traumatic brain injuries in adults but cannot be recommended in children. 

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