Research Reports - Meta-analysis of the efficacy and safety of therapeutic hypothermia in children with traumatic brain injury

World Neurosurg. 2014 Dec 13

Zhang BF(1), Wang J(2), Liu ZW(1), Zhao YL(1), Li DD(1), Huang TQ(1), Gu H(1), Song JN(3)

OBJECTIVE: To evaluate the therapeutic hypothermia on efficacy and safety of
children with acute traumatic brain injury (TBI).
METHODS: Systematic literature retrieval was carried out to obtain studies of
randomized controlled trials (RCTs) researching on therapeutic hypothermia for
children with TBI before March 2014, from PubMed, Embase, Cochrane library, CNKI,
WanFang, VIP, and CBM Databases. Data extraction and quality evaluation of RCTs
were performed by 2 investigators independently. A meta-analysis was performed by
RevMan 5.2.7.
RESULTS: Totally 7 RCTs with 442 children which 218 in hypothermia group and 224
in normothermia group were included. Meta-analysis showed therapeutic hypothermia
could increase the fatality compared to normothermia group (RR=1.84, 95%CI:
1.15-2.93, P=0.01). Glasgow outcome scale (GOS) demonstrated 3m GOS 4-5 (RR=0.89,
95%CI: 0.68-1.16, P=0.39), 3m GOS 1-3 (RR=1.19, 95%CI: 0.80-1.76, P=0.39), 6m GOS
4-5 (RR=0.91, 95%CI: 0.78-1.07, P=0.26), 6m GOS 1-3 (RR=1.18, 95%CI: 0.88-1.59,
P=0.27) did not differ between hypothermia group and normothermia group.
Hypothermia did not increase the rate of pneumonia (RR=0.84, 95%CI: 0.63-1.12,
P=0.23), or bleeding (RR=0.94, 95%CI: 0.39-2.26, P=0.89), but it might induce
arrhythmias rated to hypothermia (RR=2.60, 95%CI: 1.06-6.41, P=0.04).
CONCLUSION: Children suffered TBI may not be able to benefit from therapeutic
hypothermia, it may increase risk of fatality and arrhythmia. There is no
evidence that therapeutic hypothermia improves prognosis of children with TBI,
and no evidence that therapeutic hypothermia raise pneumonia and coagulation
dysfunction. Limited by the quality of the included studies, the results need to
be treated with caution. Further large-scale, well-designed RCTs on this topic
are still needed.

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