Two trials of hypothermia therapy in children with TBI have shown no improvement in neurologic or other outcomes one paediatric trial showed a nonsignificant increase in mortality.
Beca et al 2015
Hypothermia | Normothermia | |
Bad outcome | 17% | 12% |
Mortality | 13% | 4% |
Hutchison 2008
Bottom line
- Children with severe traumatic brain injury, hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality.
Design
- RCT, multicentre
Inclusion
- 1 to 17 years of age
- Had traumatic brain injury,
- GCS <= of 8
- CT scan that showed an acute brain injury
- Need for mechanical ventilation.
Exclusion
- Refractory shock,
- Suspected brain death,
- Nonaccidental injury,
- Prolonged cardiac arrest at the scene of the accident,
- High cervical spinal cord injury,
- Severe neurodevelopmental disability before the injury,
- Brain injury due to a gunshot wound,
- Acute isolated epidural hematoma,
- Pregnancy
Intervention
- Patients were cooled with the use of surface cooling techniques
- For rewarming, the temperature was increased at a rate of 0.5°C every 2 hours.
Sample (n=225)
- Hypothermia therapy (32.5°C for 24 hours) initiated within 8 hours after injury
- Normothermia (37°C)
Outcome at 6 months
Hypothermia | Normothermia | RR | |
Unfavorable outcome | 31% | 22% | 1.41 |
Mortality | 32% | 23% | 1.4 |
- Unfavorable outcome
- Severe disability, a persistent vegetative state, or death — at 6 months
The causes of death in the hypothermia group were brain death (4 patients), brain trauma (12), brain ischemia (1), hypoxia resulting from severe lung injury (3), and septic shock (1), with unknown causes in 2 patients. The causes of death in the normothermia group were brain death (2 patients), brain trauma (9), and brain ischemia (2), with an unknown cause in 1 patient.
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