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Therapeutic Moderate Hypothermia for Severe Traumatic Brain Injury: A Review

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Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology

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Summary

Patients with severe TBI have been treated with hypothermia for more than 50 years, though it was not until the last 15 years that the efficacy of the treatment was systematically tested. This renewed interest in therapeutic hypothermia is attributed to the discovery that moderate levels of cooling (32–33°C) could be effective and were not associated with clinically significant adverse cardiac or coagulation effects observed with lower temperatures. During this time there have been at least 14 prospective randomized clinical trials (PRCT) of the use of hypothermia to improve outcomes following severe TBI. Combined, these trials enrolled more than 1,200 patients and found that the likelihood of a good outcome was 15% higher in those who were treated with hypothermia. At least 12 studies also have evaluated the effect of hypothermia on elevated intracranial pressure (ICP) and, with a single exception, have all found a significant reduction in ICP during the period of cooling. Concomitant laboratory investigations have defined several mechanisms whereby hypothermia may reduce secondary brain injury.

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References

  1. Fay T (1959) Early experiences with local and generalized refrigeration of the human brain. J Neurosurg 16:239–259

    PubMed  CAS  Google Scholar 

  2. Sedzimir CB (1959) Therapeutic hypothermia in cases of head injury. J Neurosurg 16:407–414

    PubMed  CAS  Google Scholar 

  3. Lundberg N, Troupp H, Lorin H (1965) Continuous recording of the ventricular-fluid pressure in patients with severe acute traumatic brain injury. A preliminary report. J Neurosurg 22:581–590

    PubMed  CAS  Google Scholar 

  4. James HE, Langfitt TW, Kumar VS, et al (1977) Treatment of intracranial hypertension. Analysis of 105 consecutive, continuous recordings of intracranial pressure. Acta Neurochir (Wien) 36:189–200

    Article  CAS  Google Scholar 

  5. Clifton GL, Jiang JY, Lyeth BG, et al (1991) Marked protection by moderate hypothermia after experimental traumatic brain injury. J Cereb Blood Flow Metab 11:114–121

    PubMed  CAS  Google Scholar 

  6. Clifton GL, Allen S, Barrodale P, et al (1993) A phase II study of moderate hypothermia in severe brain injury. J Neurotrauma 10:263–271

    PubMed  CAS  Google Scholar 

  7. Marion DW, Obrist WD, Carlier PM, et al (1993) The use of moderate therapeutic hypothermia for patients with severe head injuries: A preliminary report. J Neurosurg 79:354–362

    PubMed  CAS  Google Scholar 

  8. Shiozaki T, Sugimoto H, Taneda M, et al (1993) Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. J Neurosurg 79:363–368

    PubMed  CAS  Google Scholar 

  9. Rosomoff HL (1966) Relationship of metabolism to hypothermia. Res Publ Assoc Res Nerv Ment Dis 41:116–126

    PubMed  CAS  Google Scholar 

  10. Rosomoff HL, Holaday DA (1954) Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol 179:85–88

    PubMed  CAS  Google Scholar 

  11. Donnelly C, Frobese AS, Stone HH (1956) The effect of lowered body temperature on the cerebral hemodynamics and metabolism of man. Surg Gynecol Obstet 103:313–317

    PubMed  CAS  Google Scholar 

  12. Busto R, Globus MY, Dietrich WD, et al (1989) Effect of mild hypothermia on ischemia-induced release of neurotransmitters and free fatty acids in rat brain. Stroke 20: 904–910

    PubMed  CAS  Google Scholar 

  13. Lyeth BG, Jiang JY, Robinson SE, et al (1993) Hypothermia blunts acetylcholine increase in CSF of traumatically brain injured rats. Mol Chem Neuropathol 18:247–256

    Article  PubMed  CAS  Google Scholar 

  14. Jiang JY, Liang YM, Luo QZ, et al (2004) Effect of mild hypothermia on brain dialysate lactate after fluid percussion brain injury in rodents. Neurosurgery 54:713–717

    Article  PubMed  Google Scholar 

  15. Goss JR, Styren SD, Miller PD, et al (1995) Hypothermia attenuates the normal increase in interleukin 1 beta RNA and nerve growth factor following traumatic brain injury in the rat. J Neurotrauma 12:159–167

    PubMed  CAS  Google Scholar 

  16. Chatzipanteli K, Alonso OF, Kraydieh S, et al (2000) Importance of posttraumatic hypothermia and hyperthermia on the inflammatory response after fluid percussion brain injury: Biochemical and immunocytochemical studies. J Cereb Blood Flow Metab 20:531–542

    Article  PubMed  CAS  Google Scholar 

  17. Whalen MJ, Carlos TM, Clark RS, et al (1997) The relationship between brain temperature and neutrophil accumulation after traumatic brain injury in rats. Acta Neurochir Suppl (Wien) 70:260–261

    PubMed  CAS  Google Scholar 

  18. Jiang JY, Lyeth BG, Kapasi MZ, et al (1992) Moderate hypothermia reduces blood-brain barrier disruption following traumatic brain injury in the rat. Acta Neuropathol (Berl) 84:495–500

    Article  PubMed  CAS  Google Scholar 

  19. Smith SL, Hall ED (1996) Mild pre-and posttraumatic hypothermia attenuates blood-brain barrier damage following controlled cortical impact injury in the rat. J Neurotrauma 13:1–9

    PubMed  CAS  Google Scholar 

  20. Kawai N, Nakamura T, Okauchi M, et al (2000) Effects of hypothermia on intracranial pressure and brain edema formation: Studies in a rat acute subdural hematoma model. J Neurotrauma 17:193–202

    PubMed  CAS  Google Scholar 

  21. Dietrich WD, Alonso O, Busto R, et al (1994) Post-traumatic brain hypothermia reduces histopathological damage following concussive brain injury in the rat. Acta Neuropathol (Berl) 87:250–258

    PubMed  CAS  Google Scholar 

  22. Dixon CE, Markgraf CG, Angileri F, et al (1998) Protective effects of moderate hypothermia on behavioral deficits but not necrotic cavitation following cortical impact injury in the rat. J Neurotrauma 15:95–103

    PubMed  CAS  Google Scholar 

  23. Lyeth BG, Jiang JY, Liu S (1993) Behavioral protection by moderate hypothermia initiated after experimental traumatic brain injury. J Neurotrauma 10:57–64

    PubMed  CAS  Google Scholar 

  24. Aibiki M, Maekawa S, Yokono S (2000) Moderate hypothermia improves imbalances of thromboxane A2 and prostaglandin I2 production after traumatic brain injury in humans. Crit Care Med 28:3902–3906

    Article  PubMed  CAS  Google Scholar 

  25. Aibiki M, Maekawa S, Ogura S, et al (1999) Effect of moderate hypothermia on systemic and internal jugular plasma IL-6 levels after traumatic brain injury in humans. J Neurotrauma 16:225–232

    PubMed  CAS  Google Scholar 

  26. Marion DW, Penrod LE, Kelsey SF, et al (1997) Treatment of traumatic brain injury with moderate hypothermia. N Engl J Med 336:540–546

    Article  PubMed  CAS  Google Scholar 

  27. Clark RS, Kochanek PM, Obrist WD, et al (1996) Cerebrospinal fluid and plasma nitrite and nitrate concentrations after head injury in humans. Crit Care Med 24:1243–1251

    Article  PubMed  CAS  Google Scholar 

  28. Zhang S, Zhi D, Lin X, et al (2002) Effect of mild hypothermia on partial pressure of oxygen in brain tissue and brain temperature in patients with severe head injury. Chin J Traumatol 5:43–45

    PubMed  Google Scholar 

  29. Zhao W, Alonso OF, Loor JY, et al (1999) Influence of early posttraumatic hypothermia therapy on local cerebral blood flow and glucose metabolism after fluid-percussion brain injury. J Neurosurg 90:510–519

    PubMed  CAS  Google Scholar 

  30. Metz C, Holzschuh M, Bein T, et al (1996) Moderate hypothermia in patients with severe head injury: Cerebral and extracerebral effects. J Neurosurg 85:533–541

    Article  PubMed  CAS  Google Scholar 

  31. Polderman KH, Peerdeman SM, Girbes AR (2001) Hypophosphatemia and hypomagnesemia induced by cooling in patients with severe head injury. J Neurosurg 94: 697–705

    PubMed  CAS  Google Scholar 

  32. Shiozaki T, Hayakata T, Taneda M, et al (2001) A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. J Neurosurg 94:50–54

    PubMed  CAS  Google Scholar 

  33. Clifton GL, Miller ER, Choi SC, et al (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 344:556–563

    Article  PubMed  CAS  Google Scholar 

  34. Resnick DK, Marion DW, Darby JM (1994) The effect of hypothermia on the incidence of delayed traumatic intracerebral hemorrhage. Neurosurgery 34:252–255

    Article  PubMed  CAS  Google Scholar 

  35. Jiang J, Yu M, Zhu C (2000) Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. J Neurosurg 93:546–549

    PubMed  CAS  Google Scholar 

  36. Ishikawa K, Tanaka H, Shiozaki T, et al (2000) Characteristics of infection and leukocyte count in severely head-injured patients treated with mild hypothermia. J Trauma 49:912–922

    PubMed  CAS  Google Scholar 

  37. Clifton GL, Allen S, Berry J, et al (1992) Systemic hypothermia in treatment of brain injury. J Neurotrauma 9(Suppl 2):S487–S495

    PubMed  Google Scholar 

  38. Hirayama T, Katayama Y, Kano T, et al (1994) Impact of moderate hypothermia on therapies for intracranial pressure control in severe traumatic brain injury. In: Nagai H, Ishii S, Maeda M (eds) Intracranial pressure IX: 9th International Symposium held in Nagaya, Japan, 1994. Springer-Verlag, New York, pp 233–236

    Google Scholar 

  39. Shiozaki T, Kato A, Taneda M, et al (1999) Little benefit from mild hypothermia therapy for severely head injured patients with low intracranial pressure. J Neurosurg 91: 185–191

    PubMed  CAS  Google Scholar 

  40. Yan Y, Tang W (2001) Changes of evoked potentials and evaluation of mild hypothermia for treatment of severe brain injury. Chin J Traumatol 4:8–13

    PubMed  CAS  Google Scholar 

  41. Gal R, Cundrle I, Zimova I, et al (2002) Mild hypothermia therapy for patients with severe brain injury. Clin Neurol Neurosurg 104:318–321

    Article  PubMed  Google Scholar 

  42. Zhi D, Zhang S, Lin X (2003) Study on therapeutic mechanism and clinical effect of mild hypothermia in patients with severe head injury. Surg Neurol 59:381–385

    Article  PubMed  Google Scholar 

  43. Qiu WS, Liu WG, Shen H, et al (2005) Therapeutic effect of mild hypothermia on severe traumatic head injury. Chin J Traumatol 8:27–32

    PubMed  Google Scholar 

  44. Choi SC, Bullock R (2001) Design and statistical issues in multicenter trials of severe head injury. Neurol Res 23:190–192

    Article  PubMed  CAS  Google Scholar 

  45. Clifton GL, Choi SC, Miller ER, et al (2001) Intercenter variance in clinical trials of head trauma-experience of the National Acute Brain Injury Study: Hypothermia. J Neurosurg 95:751–755

    Article  PubMed  CAS  Google Scholar 

  46. Safar P, Kochanek PM (2001) Lack of effect of induction of hypothermia after acute brain injury. N Engl J Med 345:66–61

    Article  PubMed  CAS  Google Scholar 

  47. Nara I, Shiogai T, Hara M, et al (1998) Comparative effects of hypothermia, barbiturate, and osmotherapy for cerebral oxygen metabolism, intracranial pressure, and cere-bral perfusion pressure in patients with severe head injury. Acta Neurochir Suppl 71:22–26

    PubMed  CAS  Google Scholar 

  48. Tateishi A, Soejima Y, Taira Y, et al (1998) Feasibility of the titration method of mild hypothermia in severely head-injured patients with intracranial hypertension. Neurosurgery 42:1065–1069

    Article  PubMed  CAS  Google Scholar 

  49. Takahashi I, Kitahara T, Endo M, et al (2000) [Clinical analysis of hypothermia in children with severe head injury]. No Shinkei Geka 28:983–989

    PubMed  CAS  Google Scholar 

  50. Biswas AK, Bruce DA, Sklar FH, et al (2002) Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Crit Care Med 30:2742–2751

    Article  PubMed  Google Scholar 

  51. Tokutomi T, Morimoto K, Miyagi T, et al (2003) Optimal temperature for the management of severe traumatic brain injury: Effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery 52:102–111

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Brain Trauma Foundation, New York, NY, USA

    Donald W. Marion (Senior Research Fellow)

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  1. Donald W. Marion
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Editors and Affiliations

  1. Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, 470-1192, Japan

    Tetsuo Kanno M.D., Ph.D. (Professor) & Yoko Kato M.D., Ph.D. (Associate Professor) (Professor) &  (Associate Professor)

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© 2006 Springer-Verlag Tokyo

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Marion, D.W. (2006). Therapeutic Moderate Hypothermia for Severe Traumatic Brain Injury: A Review. In: Kanno, T., Kato, Y. (eds) Minimally Invasive Neurosurgery and Multidisciplinary Neurotraumatology. Springer, Tokyo. https://doi.org/10.1007/4-431-28576-8_53

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  • DOI: https://doi.org/10.1007/4-431-28576-8_53

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-28551-9

  • Online ISBN: 978-4-431-28576-2

  • eBook Packages: MedicineMedicine (R0)

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