Hypothermia for Head Trauma

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Hypothermia for Head Trauma

Seattle Post-Intelligencer 05-04-05 Children who have suffered severe brain injuries can be safely cooled by several degrees, a treatment that some experts predict will prevent a cascade of neurological damage and save lives. According to investigator Dr. David Adelson, director of the pediatric neurotrauma center at Children's Hospital, the study is the first to examine the effects of moderate hypothermia treatment in children who sustained head trauma. The findings, published in Neurosurgery, lay the groundwork to conduct another study to see if the strategy is beneficial, Adelson said. Edward Dixon, co-director of the University of Pittsburgh's Safar Center for Resuscitation Research, called the Children's work exciting. "It really sets the stage for a larger multicenter study to definitively answer the question," he said. "It's a necessary step, (and) it's very important." Seventy-five children from six cities were in the trial. All received standard treatments, but some were randomly selected to undergo the cooling process. "They were all in a coma," Adelson said. "They all suffered a severe traumatic brain injury, so they were not responsive to the outside world." Cooling blankets and baths, ice packs and other measures took body temperatures down to about 88 degrees, or 10 degrees lower than normal. The children were kept cool for 48 hours and then rewarmed. Just like a sprained ankle, an injured brain swells and heats up, Adelson explained. But brain inflammation can lead to increased pressure within the skull and make matters worse. The goal of cooling is to reduce inflammation and limit its complications. There were not enough children in the trial to determine with certainty that hypothermia was beneficial, but the findings hinted at reductions in mortality and elevated intracranial pressure, Adelson said. They did show that the children who got the treatment were no more likely to get infections or suffer clotting problems than those who weren't cooled. He hopes that the National Institutes of Health will fund a follow-up trial that would be conducted at 12 sites and include 450 children.

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