Therapeutic hypothermia for head injury

Area of Science:

• Neurology
• Critical Care Medicine
• Trauma Management

Background:

• Mild therapeutic hypothermia has a long history in head injury treatment, with renewed interest due to recent small trials and laboratory findings.
• Cerebral protection effects of cooling in global ischemia models are well-documented.

Purpose of the Study:

• To evaluate if mild therapeutic hypothermia improves intracranial pressure (ICP) control and long-term functional outcomes in moderate to severe head injuries.
• Assessing the efficacy of mild hypothermia in patients with closed head injuries.

Main Methods:

• Systematic review of randomized controlled trials (RCTs) using electronic and manual searches.
• Included trials compared mild hypothermia (≤34-35°C for ≥12 hours) against normothermia or control.
• Data extracted on mortality, functional outcome (Glasgow Outcome Scale), complications, and ICP; analyzed using Mantel-Haenzel odds ratios.

Main Results:

• Immediate hypothermia showed a non-significant 33% reduction in mortality odds (OR 0.67) and a significant 61% reduction in death or severe disability odds (OR 0.39).
• Similar effect sizes were observed for delayed hypothermia.
• Results are based on limited data from small, single-center trials; a large multi-center trial is pending.

Conclusions:

• The review suggests a strong positive effect of therapeutic hypothermia for head injury.
• Current evidence is limited by small trial sizes and single-center studies.
• Results from a large multi-center trial are anticipated in 1999 to provide more robust evidence and inform clinical practice recommendations.