This article is part of the supplement: Update on therapeutic temperature management

Meeting abstract

Therapeutic hypothermia in traumatic brain injury

Jonathan KJ Rhodes

  • Correspondence: Jonathan KJ Rhodes

Author Affiliations

University of Edinburgh, Department of Anaesthesia, Critical Care and Pain Medicine, Intensive Care Unit, Western General Hospital, Edinburgh, UK

Critical Care 2012, 16(Suppl 2):A11 doi:10.1186/cc11269


The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/16/S2/A11


Published:7 June 2012

© 2012 Rhodes; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Meeting abstract

Hypothermia has profound effects on the brain function but importantly is potentially protective against both focal and global injuries. Aspects of the biochemical response to acute ischaemia and trauma, which are associated with poor outcome, can be inhibited by cooling. Unlike many pharmacological treatments that tend to antagonise a single neurochemical process, hypothermia offers a simple method of inhibiting multiple pathological processes simultaneously. It therefore has the potential, if applied correctly, to improve outcomes after acute brain injuries, where drug trials have so far failed.

The systemic cooling of patients after acute brain injury is an established treatment modality in many neuro-ICUs. It is a strategy for protecting the injured brain that makes intuitive sense and can reduce both intracranial pressure and the potential for ischaemic secondary insults. Basic science evidence also suggests that cooling can attenuate many secondary biochemical cascades that are activated after acute injury.

However, despite these multiple lines of supportive evidence there is as yet no confirmation from a high-quality randomised controlled trial that prophylactic hypothermia improves outcome or reduces mortality.

This talk will look at the potentially beneficial effects of hypothermia on the biochemistry of acute brain injury, consider the reasons for the failure to demonstrate clinical efficacy and review the supportive data from meta-analysis, suggesting how hypothermia might be best delivered. Finally I will discuss EuroTherm3235, a European Society of Intensive Care Medicine funded multicentre randomised controlled trial investigating prophylactic hypothermia in traumatic brain injury, which draws on the lessons from the available literature.

References

  1. Clifton GL, Valadka A, Zygun D, et al.: Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial.

    Lancet Neurol 2011, 10:131-139. PubMed Abstract | Publisher Full Text OpenURL

  2. Andrews PA, Sinclair HL, Battison CG, et al.: European Society of Intensive Care Medicine study of therapeutic hypothermia (32-35° C) for intracranial pressure reduction after traumatic brain injury (the Eurotherm 3235 trial).

    Trials 2011, 12:8. PubMed Abstract | BioMed Central Full Text | PubMed Central Full Text OpenURL