Is therapeutic hypothermia beneficial for pediatric patients with traumatic brain injury? A meta-analysis
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Published on: March 3, 2021
Chenkai Ma1, Xiaoguang He, Lin Wang
1Department of Pediatric Neurosurgery, Shanghai Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, China.
Insights
Therapeutic hypothermia for pediatric traumatic brain injury may increase mortality and cardiac arrhythmia risk. Further research is needed to confirm safety and effectiveness in children.
Area of Science:
- Neurology
- Pediatric Critical Care
- Trauma Management
Background:
- Therapeutic hypothermia shows promise in animal models for traumatic brain injury (TBI).
- Its effectiveness and safety in pediatric TBI patients remain controversial.
- This meta-analysis investigates hypothermia's role in pediatric TBI.
Purpose of the Study:
- To determine the effectiveness of hypothermia treatment for pediatric traumatic brain injury.
- To assess the safety profile of therapeutic hypothermia in this patient population.
Main Methods:
- A meta-analysis of published clinical trials was conducted.
- Data was extracted from MEDLINE, Pubmed, EMBASE, and Cochrane Library.
- Mortality and adverse events were analyzed across six trials involving 366 pediatric patients.
Main Results:
- Pediatric TBI patients treated with hypothermia showed a statistically significant increased risk of unfavorable outcomes (RR 1.73).
- Therapeutic hypothermia was associated with a significant increase in cardiac arrhythmia (RR 2.57).
- No significant difference in pneumonia risk was observed between hypothermia and normothermia groups.
Conclusions:
- Hypothermia may slightly increase mortality risk in pediatric TBI.
- Cardiac arrhythmia incidence is slightly higher with hypothermia compared to normothermia.
- More randomized controlled trials and multicenter studies are needed to elucidate the mechanism and refine therapeutic hypothermia protocols.
Purpose:
Hypothermia therapy shows its unique potential for reducing mortality in animal study and improving neurologic outcome in patients with traumatic brain injury. However, therapeutic hypothermia for pediatric traumatic brain injury remains a controversial issue. To determine the effectiveness and safety of hypothermia treatment for pediatric traumatic brain injury patients, we conducted this meta-analysis.
Patients And Methods:
We analyzed the data from MEDLINE, Pubmed, EMBASE, and Cochrane Library by electronic searching. No limitation of language was selected for analysis. We extracted the mortality and adverse events from the published trials.
Results:
Six clinical trials and 366 pediatric patients met our inclusion criteria. Pediatric patients with traumatic brain injury treated with hypothermia had more unfavorable outcome than those in the normothermia group (RR 1.73, 95 % CI 1.06 to 2.84), and this increased risk is statistically significant. Patients with therapeutic hypothermia are slightly likely to be induced by cardiac arrhythmia, and the likelihood is also significant (RR 2.57, 95 % CI 1.01 to 6.54). Risk of pneumonia has no statistical difference between normothermia and hypothermia arms (RR 0.90, 95 % CI 0.73 to 1.12). Two of the included trials have reported their detail randomization assignment.
Conclusions:
Hypothermia may slightly increase the risk of mortality in children with traumatic brain injury and the ratio of cardiac arrhythmia after this hypothermia therapy is slightly higher than that in normothermia groups. In the future, more randomized controlled trials and multicenter studies on the mechanism of therapeutic hypothermia are required.
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