Early induction of hypothermia for evacuated intracranial hematomas: a post hoc analysis of two clinical trials.

摘要: Object. The authors hypothesized that cooling before evacuation of traumatic intracranial hematomas protects the brain from reperfusion injury and, if so, further hypothermia induction or soon after craniotomy should be associated with improved outcomes. Methods. National Acute Brain Injury Study: Hypothermia I (NABIS:H I) was a randomized multicenter clinical trial 392 patients severe treated using normothermia for 48 hours reaching 33°C at 8.4 ± 3 injury. II II) randomized, 97 35°C within 2.6 1.2 and 4.4 1.5 Entry exclusion criteria, management, outcome measures in 2 trials were similar. Results. In NABIS:H among evacuated hematomas, poor (severe disability, vegetative state, death) 5 15 group 9 13 (relative risk 0.44, 95% CI 0.22–0.88; p = 0.02). All to reached surgery start 5.55 hours. Applying these criteria I, 31 54 hypothermia-treated temperature lower time, remaining 23 later time points. Outcome 14 (45%) surgery, (61%) more than 35 (60%) 58 0.74, 95%, 0.49–1.13; 0.16). A meta-analysis 46 both who showed significantly reduced rate outcomes (41%) compared 94 did not reach (62%, 0.009). Conclusions. Induction maintenance thereafter may improve Clinical registration no.: NCT00178711.