Research Reports - Role of therapeutic hypothermia in improving outcome after traumatic brain injury: a systematic review

Br J Anaesth. 2013 Mar;110(3):357-67

Georgiou AP, Manara AR

This systematic review delineates the effect of primary therapeutic hypothermia
(PTH) (initiated on presentation of the patient) on both mortality and
neurological outcome in patients with traumatic brain injury. The safety profile
of the therapy is also assessed. A systematic search of the following databases
was performed: MEDLINE, EMBASE, Zetoc database of conference proceedings, the
Cochrane Database of Systematic Reviews, and the clinicaltrials.gov website, up
to July 28, 2011. Relevant journals were hand-searched for further articles and
reference lists were checked against the retrieved results for additional
resources. The retrieved results were filtered for randomized controlled trials
in English where systemic hypothermia was applied for ≥12 h in the treatment arm
and outcome was assessed at a minimum of 3 months. Randomized controlled trials
were assessed for quality of evidence using the GRADE system. Eighteen randomized
controlled trials (1851 patients) were identified. The overall relative risk of
mortality with PTH when compared with controls was 0.84 [95% confidence interval
(CI)=0.72-0.98] and of poor neurological outcome was 0.81 (95% CI=0.73-0.89).
However, when only high-quality trials were analysed, the relative risks were
1.28 (95% CI=0.89-1.83) and 1.07 (95% CI=0.92-1.24), respectively. Hypothermia
was associated with cerebrovascular disturbances on rewarming and possibly with
pneumonia in adult patients. Given the quality of the data currently available,
no benefit of PTH on mortality or neurological morbidity could be identified. The
therapy should therefore only be used within the confines of well-designed
clinical trials.

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