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Previous Volume 344:556-563 February 22, 2001 Number 8 Next

	Full Text PDF Editorial by Narayan, R. K. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

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°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°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°C within eight hours after injury, is not effective in improving outcomes in patients with severe brain injury.

Source Information

From the Vivian L. Smith Center for Neurologic Research, Department of Neurosurgery, University of Texas–Houston Medical School, Houston (G.L.C., E.R.M.); the Departments of Biostatistics and Neurosurgery, Medical College of Virginia, Virginia Commonwealth University, Richmond (S.C.C.); the Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston (H.S.L., S.M.); the Department of Neurosurgery, St. Louis University, St. Louis (K.R.S.); the Department of Neurological Surgery, University of California at Davis, Sacramento (J.P.M., F.C.W.); the Brain Trauma Research Center, Department of Neurosurgery, University of Pittsburgh, Pittsburgh (D.W.M.); the Division of Neurosurgery, Indiana University, Indianapolis (T.G.L.); the Department of Neurosurgery, Oregon Health Sciences University, Portland (R.M.C.); and the Department of Neurosurgery, Sunnybrook Medical Centre, University of Toronto, Toronto (M.S.).

Address reprint requests to Dr. Clifton at the Department of Neurosurgery, Vivian L. Smith Center for Neurologic Research, University of Texas–Houston Health Science Center, 6431 Fannin, Suite 7.148, Houston, TX 77030, or at guy.l.clifton{at}uth.tmc.edu.

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