IS HYPOTHERMIA IN THE VICTIM OF MAJOR TRAUMA PROTECTIVE OR HARMFUL - A RANDOMIZED, PROSPECTIVE-STUDY

Objective The purpose of this randomized, prospective clinical trial w as to determine whether hypothermia during resuscitation is protective or harmful to critically injured trauma patients. Summary Background Data Hypothermia has both protective and harmful clinical effects. Ret rospective studies show higher mortality in patients with hypothermia; however, hypothermia is more common in more severely injured patients , which makes it difficult to determine whether hypothermia contribute s to mortality independently of injury severity. There are no randomiz ed, prospective treatment studies to assess hypothermia's impact as an independent variable. Methods Fifty-seven hypothermic (T less than or equal to 34.5 C), critically injured patients requiring a pulmonary a rtery catheter were randomized to a rapid rewarming protocol using con tinuous arteriovenous rewarming (CAVR) or to a standard rewarming (SR) control group. The primary outcome of interest was first 24-hour bloo d product and fluid resuscitation requirements. Other comparative anal yses included coagulation assays, hemodynamic and oxygen transport mea surements, length of stay, and mortality. Results The two groups were well matched for demographic and injury severity characteristics. CAVR rewarmed significantly faster than did SR (p < 0.01), producing two g roups with different amounts of hypothermia exposure. The patients who underwent CAVR required less fluid during resuscitation to the same h emodynamic goals (24,702 mL vs. 32,540 mL, p = 0.05) and were signific antly more likely to rewarm (p = 0.002). Only 2 (7%) of 29 patients wh o underwent CAVR failed to warm to 36 C and both died, whereas 12 (43% ) of 28 patients who underwent SR failed to reach 38 C, and all 12 die d. Patients who underwent CAVR had significantly less early mortality (p = 0.047). Conclusion Hypothermia increases fluid requirements and i ndependently increases acute mortality after major trauma.