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Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients

Crompton, Ellie M., Lubomirova, Irina, Cotlarciuc, Ioana, Han, Thang S., Sharma, Sapna D., Sharma, Pankaj·2017·Critical Care Medicine
DOI 10.1097/ccm.0000000000002205
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Abstract

Objective: Therapeutic hypothermia has been used to attenuate the effects of traumatic brain injuries. However, the required degree of hypothermia, length of its use, and its timing are uncertain. We undertook a comprehensive meta-analysis to quantify benefits of hypothermia therapy for traumatic brain injuries in adults and children by analyzing mortality rates, neurologic outcomes, and adverse effects. Data Sources: Electronic databases PubMed, Google Scholar, Web of Science, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov and manual searches of studies were conducted for relevant publications up until February 2016. Study Selection: Forty-one studies in adults ( n = 3,109; age range, 18–81 yr) and eight studies in children ( n = 454; age range, 3 mo to 18 yr) met eligibility criteria. Data Extraction: Baseline patient characteristics, enrollment time, methodology of cooling, target temperature, duration of hypothermia, and rewarming protocols were extracted. Data Synthesis: Risk ratios with 95% CIs were calculated. Compared with adults who were kept normothermic, those who underwent therapeutic hypothermia were associated with 18% reduction in mortality (risk ratio, 0.82; 95% CI, 0.70–0.96; p = 0.01) and a 35% improvement in neurologic outcome (risk ratio, 1.35; 95% CI, 1.18–1.54; p < 0.00001). The optimal management strategy for adult patients included cooling patients to a minimum of 33°C for 72 hours, followed by spontaneous, natural rewarming. In contrast, adverse outcomes were observed in children who underwent hypothermic treatment with a 66% increase in mortality (risk ratio, 1.66; 95% CI, 1.06–2.59; p = 0.03) and a marginal deterioration of neurologic outcome (risk ratio, 0.90; 95% CI, 0.80–1.01; p = 0.06). Conclusions: Therapeutic hypothermia is likely a beneficial treatment following traumatic brain injuries in adults but cannot be recommended in children.

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Metadata

Authors
Crompton, E. M., Lubomirova, I., Cotlarciuc, I., Han, T. S., Sharma, S. D., & Sharma, P.
Affiliations
  • Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL), Egham, United Kingdom.
  • Department of Medicine, Imperial College London, London, United Kingdom.
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2017-04
Volume
45
Issue
4
Pages
575-583
ISSN
0090-3493
DOI
10.1097/ccm.0000000000002205
Cited by
89
References
0
Language
en

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Crompton, E. M., Lubomirova, I., Cotlarciuc, I., Han, T. S., Sharma, S. D., & Sharma, P. (2017). Meta-Analysis of Therapeutic Hypothermia for Traumatic Brain Injury in Adult and Pediatric Patients. Critical Care Medicine. https://doi.org/10.1097/ccm.0000000000002205

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