Trial of Edaravone for severe hypoxic ischemic encephalopathy in adults: a double-blind placebo-controlled study

Hypoxic ischemic encephalopathy (HIE) is a severe brain injury that can lead to death and long-term disability. HIE can be treated with therapeutic hypothermia, and various adjuvant treatments (such as melatonin) are also utilized. Adjuvant therapies are not recommended outside clinical trials, and therapeutic hypothermia is not universally available. This study aimed to investigate the effects of Edaravone on improving levels of consciousness, hemodynamic stability, and short-term clinical outcomes of adult patients with severe HIE. To the best of our knowledge, this study is the first randomized clinical trial investigating the effects of Edaravone in adult patients with severe HIE.

A double-blind clinical trial enrolled 72 severe HIE patients (aged > 18) within 24 h of onset who were diagnosed clinically and radiologically. Patients were randomized to Edaravone group (n = 20) and non-Edaravone group (n = 52). Measured parameters included level of consciousness, vital signs, Barthel index, and patient outcome (death or discharge). Statistical analysis was performed using SPSS version 27, with a significance level of P < 0.05.

In short-term assessment of the patient's level of consciousness, the Edaravone group showed significant improvement in the Glasgow Coma Scale (GCS) post-intervention (p = 0.001). While the Edaravone group and non-Edaravone group showed no significant difference in outcome (p = 0.863) and Barthel score for discharged patients (P = 0.557). Vital signs showed significant differences between groups in temperature (P = 0.002). In the comparison of comorbidities between the Edaravone and non-Edaravone groups, only coronary artery bypass grafting was significantly different (P = 0.021).

Edaravone improved the short-term level of consciousness in severe HIE adult patients, but there was no significant effect on outcome and level of independence in performing activities of daily living. Further investigation into Edaravone's effectiveness is warranted, particularly in patients with milder forms of HIE, as well as longer follow-up periods.