This study, recently published in JAMA, revealed no beneficial effect from hypothermia as an adjunct to decompressive hemicraniectomy in the setting of middle cerebral artery stroke. In fact, the authors’ findings even suggest harm. Find the article here.
POLAR RCT is probably the most anticipated neurotrauma trial of the year and its findings were finally presented at this year’s ESICM congress in Paris. Before I comment on what POLAR RCT is all about, it’s worth taking some time to consider what this trial is NOT about. It does not deal specifically with TBI… Continue reading POLAR RCT – Don’t Worry, Thermoregulation Isn’t Dead Quite Yet
Targeted temperature management (TTM) as a neuroptotective strategy is applied in a number of scenarios; post-ROSC in cardiac arrest, neonatal asphyxia, traumatic brain injury, to name some. The Neurocritical Care Society have taken it upon themselves to formulate an evidence-based guideline to the implementation and practical management of TTM in a number of settings. Although… Continue reading TTM – New Guidelines from NCS
Results from the HYBERNATUS trial were just published in the New England Journal of Medicine by Legriel et al. This study recruited 270 patients with convulsive status epilepticus, randomized to either therapeutic hypothermia (32-34 C) or normothermia. All patients were intubated and on controlled ventilation when included. All received standard antiepileptic pharmacological treatment. Primary outcome… Continue reading HYBERNATUS Trial: Hypothermia Not Associated With Better Outcomes in Status Epilepticus
The long-awaited Eurotherm trial was published in NEJM in autumn 2015. The premise of the study was to examine the impact of induced hypothermia on outcomes after traumatic brain injury. In a multi center randomized controlled trial patients were allocated to either therapeutic hypothermia (32-35 degrees) or the control group (standard care, normothermia). The study… Continue reading Eurotherm 3235 Trial
Excellent talk by Manoj Saxena on traumatic brain injury and temperature control. A useful overview of the available evidence. From SMACC Chicago 2015.
Just off the press: Cochrane Collaboration Review of the use of therapeutic hypothermia after cardiopulmonary resuscitation. “Evidence of moderate quality suggests that conventional cooling methods provided to induce mild therapeutic hypothermia improve neurological outcome after cardiac arrest, specifically with better outcomes than occur with no temperature management” The updated Cochrane review goes a long way… Continue reading Cochrane Review – Hypothermia for Neuroprotection after Cardiac Arrest
“There was no difference in the incidence of impairment between hypothermic and normothermic groups” Abstract: Effects of intraoperative hypothermia on neuropsychological outcomes after intracranial aneurysm surgery. Ann Neurol 2006. Anderson et al.
Free full-text via PubMed at: Intraoperative Hypothermia for Aneurysm Surgery Trial (IHAST) Investigators. Mild intraoperative hypothermia during surgery for intracranial aneurysm. Todd et al. NEJM 2005. “Intraoperative hypothermia did not improve the neurologic outcome after craniotomy among good-grade patients with aneurysmal subarachnoid haemorrhage”
This Cochrane Review by Saxena et al from 2014 reveals a paucity of RCTs to support moderate therapeutic hypothermia in TBI patients. It remains a widely used modality in spite of this absence of evidence. “In order to further explore the preliminary findings provided by animal models and observational clinical studies that suggests there may… Continue reading Cochrane Review – Modest cooling therapies (35ºC to 37.5ºC) for traumatic brain injury