Dw. Marion et al., THE USE OF MODERATE THERAPEUTIC HYPOTHERMIA FOR PATIENTS WITH SEVERE HEAD-INJURIES - A PRELIMINARY-REPORT, Journal of neurosurgery, 79(3), 1993, pp. 354-362
Animal research suggests that moderate therapeutic hypothermia may imp
rove outcome after a severe head injury, but its efficacy has not been
established in humans. The authors randomly assigned 40 consecutively
treated patients with a severe closed head injury (Glasgow Coma Scale
score 3 to 7) to either a hypothermia or a normothermia group. Using
cooling blankets and cold saline gastric lavage, patients in the hypot
hermia group were cooled to 32-degrees to 33-degrees-C (brain temperat
ure) within a mean of 10 hours after injury, maintained at that temper
ature for 24 hours, and rewarmed to 37-degrees to 38-degrees-C over 12
hours. Patients in the normothermia group were maintained at 37-degre
es to 38-degrees-C during this time. Deep-brain temperatures were moni
tored directly and used for all temperature determinations. Intracrani
al pressure (ICP), cerebral blood flow (CBF), and cerebral metabolic r
ate for oxygen (CMRO2) were measured serially for all patients. Hypoth
ermia significantly reduced ICP (40%) and CBF (26%) during the cooling
period, and neither parameter showed a significant rebound increase a
fter patients were rewarmed. Compared to the normothermia group, the m
ean CMRO2 in the hypothermia group was lower during cooling and higher
5 days after injury. Three months after injury, 12 of the 20 patients
in the hypothermia group had moderate, mild, or no disabilities; eigh
t of the 20 patients in the normothermia group had improved to the sam
e degree. Both groups had a similar incidence of systemic complication
s, including cardiac arrhythmias, coagulopathies, and pulmonary compli
cations. It is concluded that therapeutic moderate hypothermia is safe
and has sustained favorable effects on acute derangements of cerebral
physiology and metabolism caused by severe closed head injury. The tr
end toward better outcome with hypothermia may indicate that its benef
icial physiological and metabolic effects limit secondary brain injury
.