Lack of effect of induction of hypothermia after acute brain injury.
BACKGROUND
Induction of hypothermia in patients with brain injury was shown to improve outcomes in small clinical studies, but the results were not definitive. To study this issue, we conducted a multicenter trial comparing the effects of hypothermia with those of normothermia in patients with acute brain injury.


METHODS
The study subjects were 392 patients 16 to 65 years of age with coma after sustaining closed head injuries who were randomly assigned to be treated with hypothermia (body temperature, 33 degrees C), which was initiated within 6 hours after injury and maintained for 48 hours by means of surface cooling, or normothermia. All patients otherwise received standard treatment. The primary outcome measure was functional status six months after the injury.


RESULTS
The mean age of the patients and the type and severity of injury in the two treatment groups were similar. The mean (+/-SD) time from injury to randomization was 4.3+/-1.1 hours in the hypothermia group and 4.1+/-1.2 hours in the normothermia group, and the mean time from injury to the achievement of the target temperature of 33 degrees C in the hypothermia group was 8.4+/-3.0 hours. The outcome was poor (defined as severe disability, a vegetative state, or death) in 57 percent of the patients in both groups. Mortality was 28 percent in the hypothermia group and 27 percent in the normothermia group (P=0.79). The patients in the hypothermia group had more hospital days with complications than the patients in the normothermia group. Fewer patients in the hypothermia group had high intracranial pressure than in the normothermia group.


CONCLUSIONS
Treatment with hypothermia, with the body temperature reaching 33 degrees C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.
Clifton
G L
GL
Vivian L Smith Center for Neurologic Research, Department of Neurosurgery, University of Texas-Houston Medical School, 77030, USA. guy.l.clifton@uth.tmc.edu
Miller
E R
ER
Choi
S C
SC
Levin
H S
HS
McCauley
S
S
Smith
K R
KR
Muizelaar
J P
JP
Wagner
F C
FC
Marion
D W
DW
Luerssen
T G
TG
Chesnut
R M
RM
Schwartz
M
M
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D015600:Glasgow Coma Scale; D006801:Humans; D007035:Hypothermia / Q000150:complications; D007036:Hypothermia, Induced; D007427:Intracranial Pressure; D008875:Middle Aged; D017211:Treatment Failure