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

作者：Guy L. Clifton, Christopher S. Coffey, Sierra Fourwinds, David Zygun, Alex B. Valadka, Kenneth R. Smith, Melisa L. Frisby, Richard D. Bucholz, Elisabeth A. Wilde, Harvey S. Levin, David O. Okonkwo · 发表于：Journal of neurosurgery · 年份：2012 · DOI：10.3171/2012.6.jns111690 · 被引用次数：62 · 研究领域：Thermal Regulation in Medicine、Traumatic Brain Injury and Neurovascular Disturbances、Cardiac Arrest and Resuscitation

OBJECT: The authors hypothesized that cooling before evacuation of traumatic intracranial hematomas protects the brain from reperfusion injury and, if so, further hypothesized that hypothermia induction before or soon after craniotomy should be associated with improved outcomes. METHODS: The National Acute Brain Injury Study: Hypothermia I (NABIS:H I) was a randomized multicenter clinical trial of 392 patients with severe brain injury treated using normothermia or hypothermia for 48 hours with patients reaching 33°C at 8.4 ± 3 hours after injury. The National Acute Brain Injury Study: Hypothermia II (NABIS:H II) was a randomized, multicenter clinical trial of 97 patients with severe brain injury treated with normothermia or hypothermia for 48 hours with patients reaching 35°C within 2.6 ± 1.2 hours and 33°C within 4.4 ± 1.5 hours of injury. Entry and exclusion criteria, management, and outcome measures in the 2 trials were similar. RESULTS: In NABIS:H II among the patients with evacuated intracranial hematomas, outcome was poor (severe disability, vegetative state, or death) in 5 of 15 patients in the hypothermia group and in 9 of 13 patients in the normothermia group (relative risk 0.44, 95% CI 0.22-0.88; p = 0.02). All patients randomized to hypothermia reached 35°C within 1.5 hours after surgery start and 33°C within 5.55 hours. Applying these criteria to NABIS:H I, 31 of 54 hypothermia-treated patients reached a temperature of 35°C or lower within 1.5 hours after surgery ...