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Hypothermia for traumatic head injury

  1. Emma Sydenham1,*,
  2. Ian Roberts1,
  3. Phil Alderson2

Editorial Group: Cochrane Injuries Group

Published Online: 7 OCT 2009

Assessed as up-to-date: 6 APR 2009

DOI: 10.1002/14651858.CD001048.pub4

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How to Cite

Sydenham E, Roberts I, Alderson P. Hypothermia for traumatic head injury. Cochrane Database of Systematic Reviews 2009, Issue 2. Art. No.: CD001048. DOI: 10.1002/14651858.CD001048.pub4.

Author Information

  1. 1

    London School of Hygiene & Tropical Medicine, Cochrane Injuries Group, London, UK

  2. 2

    National Institute for Health and Clinical Excellence, Manchester, UK

*Emma Sydenham, Cochrane Injuries Group, London School of Hygiene & Tropical Medicine, Room 280, Keppel Street, London, WC1E 7HT, UK. emma.sydenham@Lshtm.ac.uk.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 7 OCT 2009

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References

References to studies included in this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Adelson 2005 HYPO1 {published data only}
  • Adelson PD, Ragheb J, Muizelaar JP, Kanev P, Brockmeyer D, Beers S, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56(4):740-54. [DOI: ]
Adelson 2005 HYPO2 {published data only}
  • Adelson PD, Ragheb J, Muizelaar JP, Kanev P, Brockmeyer D, Beers S, et al. Phase II clinical trial of moderate hypothermia after severe traumatic brain injury in children. Neurosurgery 2005;56(4):740-54. [DOI: ]
Aibiki 2000 {published data only}
  • Aibiki M, Maekawa S, Yokono S. Moderate hypothermia improves imbalances of thromboxane A2 and prostaglandin I2 production after traumatic brain injury in humans. Critical Care Medicine 2000;28(12):3902-6.
Biswas 2002 {published data only}
  • Biswas AK, Bruce DA, Sklar FH, Bokovoy JL, Sommerauer JF. Treatment of acute traumatic brain injury in children with moderate hypothermia improves intracranial hypertension. Critical Care Medicine 2002;30(12):2742-51. [DOI: ]
Clifton 1992 {published and unpublished data}
Clifton 1993 {published data only}
  • Clifton GL. Hypothermia and hyperbaric oxygen as treatment modalities for severe head injury. New Horizons 1995;3:474-8.
  • Clifton GL. Hypothermia in the management of patients with head injury. Abstracts of the 2nd International Neurotrauma Symposium. Glasgow, 1993; Vol. July 4-9.
  • Clifton GL. Systemic hypothermia in treatment of severe brain injury. Journal of Neurosurgical Anesthesiology 1995;7:152-6.
  • Clifton GL. Systemic hypothermia in treatment of severe brain injury: A review and update. Journal of Neurotrauma 1995;12:923-7.
  • Clifton GL, Allen S, Barrodale P, Plenger P, Berry J, Koch S, Fletcher J, Hayes RL, Choi SC. A phase II study of moderate hypothermia in severe brain injury. Journal of Neurotrauma 1993;10:263-73.
Clifton 2001 {published data only}
  • Clifton GL. Hypothermia in Neurotrauma. Abstracts of the 3rd International Neurotrauma Symposium. Toronto, Canada, 1995:July 22-27.
  • Clifton GL, Miller ER, Choi SC, Levin HS, McCauley S, Smith KR, et al. Lack of effect of induction of hypothermia after acute brain injury. New England Journal of Medicine 2001;344(8):556-63.
Harris 2009 {published and unpublished data}
  • Harris OA, Muh CR, Suries MC, Pan Y, Rozycki G, Macleod J, Easley K. Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial. Journal of Neurosurgery 2009 Feb 27 (epub ahead of print).
Hashiguchi 2003 {published data only}
  • Hashiguchi N, Shiozaki T, Ogura H, Tanaka H, Koh T, Noborio M, et al. Mild hypothermia reduces expression of heat shock protein 60 in leukocytes from severely head-injured patients. The Journal of Trauma Injury, Infection, and Critical Care 2003;55:1054-60. [DOI: ]
Hirayama 1994 {published data only}
  • Hayashi N, Hirayama T, Udagawa A, Daimon W, Ohata M. Systemic Management of Cerebral Edema Based on a New Concept in Severe Head Injury Patients. Acta Neurochirurgica 1994;60(supplement):541-3.
  • Hayashi N, Shibuya T, Kinoshita K, Jo S, Azuhata T, Mera K, Tanjo K. The cerebral thermal dysregulation and hypothermia treatment in severe brain injury patients. Abstracts of the Tenth International Symposium on Intracranial Pressure and Neuromonitoring in Brain Injury. Williamsburg USA, 1997:May 25-29.
  • Hirayama T, Katayama Y, Kano T, Hayashi N, Tsubokawa T. Impact of Moderate Hypothermia on Therapies for Intracranial Pressure Control in Severe Traumatic Brain Injury. In: Nagai H, Ishii S, Maeda M editor(s). Intracranial Pressure IX. Tokyo: Springer-Verlag, 1994:233-6.
  • Hirayama T, Katayama Y, Maeda T, Kawamata T, Tsubokawa T. Effects of moderate hypothermia on the evolution of cerebral contusion. Abstracts of the 3rd International Neurotrauma Symposium. Toronto, Canada, 1995:July 22-27.
Hutchison 2008 {published data only}
Ishikura 1998 {published data only}
  • Ishikura H, Yamagami K, Akahori M, Shoji Y, Fukui H, Tanaka T. Changes in Blood Platelet Count and Serum Thrombopoetin (TPO) level under Moderate Hypothermic Therapy in Traumatic Severe Closed Head Injury. Critical Care Medicine 1998;26(Supplement 1):A82.
Jiang 2000 {published data only}
  • Jiang JY, Yu MK, Zhu C. Effect of long-term mild hypothermia therapy in patients with severe traumatic brain injury: 1-year follow-up review of 87 cases. Journal of Neurosurgery 2000;93:546-9.
  • Jiang JY, Zhu C. The mild hypothermia significantly decreases mortality of severe traumatic brain injured patients. Abstracts of the International Conference on Recent Advances in Neurotraumatology, Riccione, Italy, Sept 8-11 1996. 1996.
Marion 1997 {published data only}
  • Clark RSB, Kochanek PM, Obrist WD, Wong HR, Billiar TR, Wisniewski SR, Marion DW. Cerebrospinal fluid and plasma nitrite and nitrate concentrations after head injury in humans. Critical Care Medicine 1996;24:1243-51.
  • Darby JM, Marion DW, Peitzman A, Carlier P, Obrist WD. Pulmonary complications in brain-injured patients treated with hypothermia. Anesthesiology 1992;77:A295.
  • Marion DW, Carlier P. Moderate therapeutic hypothermia improves outcome following severe traumatic brain injury. Abstracts of the 3rd International Neurotrauma Symposium. Toronto, Canada, 1995:July 22-27.
  • Marion DW, Obrist WD, Carlier PM, Penrod LE, Darby JM. The use of moderate therapeutic hypothermia for patients with severe head injuries: a preliminary report. Journal of Neurosurgery 1993;79:354-62.
  • Marion DW, Palmer AM, DeKosky ST, Kochanek PM, Carlier PM. Effect of moderate hypothermia on neurochemical mediators of secondary brain injury. Journal of Neurosurgery 1995;82:344A.
  • Marion DW, Penrod LE, Kelsey SF, Obrist WD, Kochanek PM, Palmer AM, Wisniewski SR, DeKosky ST. Treatment of traumatic brain injury with moderate hypothermia. Abstracts of the Tenth International Symposium on Intracranial Pressure and Neuromonitoring in Brain Injury. Williamsburg USA, 1997:May 25-29.
  • Marion DW, Penrod LE, Kelsey SF, Obrist WD, Kochanek PM, Palmer AM, Wisniewski SR, DeKosky ST. Treatment of traumatic brain injury with moderate hypothermia. New England Journal of Medicine 1997;336:540-6.
  • Resnick DK, Marion DW, Darby JM. The effect of hypothermia on the incidence of delayed traumatic intracerebral hemorrhage. Neurosurgery 1994;34:252-6.
Meissner 2003a {published data only}
  • Meissner W, Fritz H, Dohm B, Krapp C, Reinhart K. Hormonal and haemodynamic consequences of moderate hypothermia in head injured patients. Neurosciences 2003:102-3.
Meissner 2003b {published data only}
  • Meissner W, Krapp C, Kauf E, Dohrn B, Reinhart K. Thyroid hormone response to moderate hypothermia in severe brain injury. Intensive Care Medicine 2003;29:44-8. [DOI: ]
Qiu 2007 {published data only}
  • Qiu W, Zhang Y, Sheng H, Zhang J, Wang W, Liu W, et al. Effects of therapeutic mild hypothermia on patients with severe traumatic brain injury after craniotomy. Journal of critical care 2007;22:229-36.
Shiozaki 1993 {published and unpublished data}
  • Shiozaki T, Sugimoto H, Taneda M, Yoshida H, Iwai A, Yoshioka T, Sugimoto T. Effect of mild hypothermia on uncontrollable intracranial hypertension after severe head injury. Journal of Neurosurgery 1993;79:363-8.
Shiozaki 1999 {published data only}
  • Shiozaki T, Kato A, Taneda M, Hayakata T, Hashiguchi N, Tanaka H. Little benefit from mild hypothermia therapy for severely head injured patients with low intracranial pressure. Journal of Neurosurgery 1999;91:185-91.
Shiozaki 2001 {published data only}
  • Shiozaki T, Hayakata T, Taneda M, Nakajima Y, Hashiguchi N, Fujimi S, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Journal of Neurosurgery 2001;94:50-4.
Smrcka 2005 {published data only}
  • Smrcka M, Vidlak M, Maca K, Smrcka V, Gal R. The influence of mild hypothermia on ICP, CPP and outcome in patients with primary and secondary brain injury. Acta Neurochirurgica 2005;95(Suppl):273-5.
Yan 2001 {published data only}
  • Yan Y, Tang W. Changes of evoked potentials and evaluation of mild hypothermia for treatment of severe brain injury. Chinese Journal of Traumatology 2001;4:8-13.
Zhang 2000 {published data only}
  • Zhang K, Wang JX. Comparative study on mild hypothermia in patients with severe head injury and the most severe head injury. Inner Mongolia Medical Journal 2000;32:4-6.

References to studies excluded from this review

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Bayir 2009 {published data only}
  • Bayir H, Adelson PD, Wisniewski SR, Shore P, Lai Y, Brown D, Janesko-Feldman KL, et al. Therapeutic hypothermia preserves antioxidant defenses after severe traumatic brain injury in infants and children. Critical care medicine 2009;37(2):689-95.
Chen 2001 {published data only}
  • Chen L, Piao Y, Zeng F, Lu M, Kuang Y, Li X. Moderate hypothermia therapy for patients with severe head injury. Chinese Journal of Traumatology (English edition) 2001;4(3):164-7.
Chouhan 2006 {published data only}
  • Chouhan RS, Dash HH, Bithal PK, Chaturvedi A, Pandia MP, Radhakrishnan M, et al. Intraoperative mild hypothermia for brain protection during intracranial aneurysm surgery. Journal of Anaesthesiology and Clinical Pharmacology 2006;22(1):21-8.
Fukuoka 2004 {published data only}
  • Aibiki M. Personal communication with author. September 10, 2008.
  • Fukuoka N, Aibiki M, Tsukamoto T, Seki K, Morita S. Biphasic concentration change during continuous midazolam administration in brain-injured patients undergoing therapeutic moderate hypothermia. Resuscitation 2004;60:225-30.
Gal 2002 {published data only}
Gentilello 1997 {published data only}
Guo 2004 {published data only}
  • Guo W, Wang L-L, Cai K-H. A control study on mild hypothermia in treatment of severe craniocerebral injury. Journal of Xinxiang Medical College 2004;21(4):269-71.
Hayashi 2002 {published data only}
  • Hayashi S, Inao S, Takayasu M, Kajita Y, Ishiyama J, et al. Effect of early induction of hypothermia on severe head injury (abstract). Acta Neurochirurgica 2002;81(Suppl):83-4. [PUBMED: 12168365]
Hayashi 2005 {published data only}
  • Hayashi S, Takayasu M, Inao S, Yoshida J. Balance of risk of therapeutic hypothermia. Acta Neurochirurgica 2005;95(Suppl):269-72.
Legros 1985 {published data only}
  • Legros B, Lapierre F, Laudat P, Krettly PH, Fournier P, Meny J, et al. Barbiturate hypothermia treatment for post-traumatic brain injury:infectious complications and mortality [Barbiturici-ipotermia nella protezione metabolica cerebrale post-traumatica: complicazioni infettive e mortalita]. Minerva Anesthesiologica 1985;51:525-30.
Li 2008 {published data only}
  • Li G, XU R-X, Ke Y-Q, Jiang X-C, Zhang S-F, Deng B-L, Yu X. Effect of sub-hypothermia therapy on coagulopathy after severe head injury. Chinese medical journal 2008;121(22):2350-2.
Liu 2005 {published data only}
  • Liu W, An Y-H, Liu E-Z, Yu C-J. Effect of mild hypothermia combined with hibernation on the homeostasis of patients with severe head injury. Chinese Journal of Clinical Rehabilitation 2005;9(33):175-7.
Liu 2006 {published data only}
  • Liu WG, Qiu WS, Zhang Y, Wang WM, Lu F, Yang XF. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. The Journal of International Medical Research 2006;34:58-64.
Meissner 1998 {published and unpublished data}
  • Meissner W, Fritz H, Dohrn B, Specht M, Reinhart K. Influence of Hypothermia on Cytokine Concentrations in Head Injured Patients. Critical Care Medicine 1998;26(Supplement 1):A82.
Mrlian 2006 {published data only}
  • Mrlian A, Smrcka M, Klabusay M. The use of controlled mild hypothermia and immune system status in patients with severe brain injury. Bratisl Lek Listy 2006;107(4):113-7.
Nara 1997 {published data only}
  • Nara I, Shiogai T, Saruta K, Hara M, Saito I. Comparative effects of hypothermia, barbiturates, and osmotherapy for cerebral oxygen metabolism, intracranial pressure and cerebral perfusion pressure in patients with severe head injury. Abstracts of the Tenth International Symposium on Intracranial Pressure and Neuromonitoring in Brain Injury. Williamsburg USA, 1997:May 25-29.
Nordby 1984 {published data only}
Qiu 2005 {published data only}
  • Qiu WS, Liu WG, Shen H, Wang WM, Zhang SL, Zhang Y, et al. Therapeutic effect of mild hypothermia on severe traumatic head injury. Chinese Journal of Traumatology 2005;8(1):27-32.
Qiu 2006 {published data only}
  • Qiu W, Wang W, Du H, Liu W, Shen H, Shen L, et al. Thrombocytopenia after therapeutic hypothermia in severe traumatic brain injury. Chinese Journal of Traumatology 2006;9(4):238-41.
Schulman 2005 {published data only}
  • Schulman C, Namias N, Doherty J, Manning R, Li P, Alhaddad A, et al. The effect of antipyretic therapy upon outcomes in critically ill patients: a randomized, prospective study. Surgical interventions 2005;6(4):369-75.
Shen 2000 {published data only}
  • Shen JH, Shen MW. Application of mild hypothermia in treatment of severe brain injury. Heibei Med J 2000;6:498-500.
Wang 2005 {published data only}
  • Wang WP, Ren HJ, Chi JY, Xu FL, Quan Y. Effects of mild hypothermia on patients with lower intracranial pressure following severe brain injury. Chinese Journal of Traumatology 2005;8(1):54-6.
Wang 2007 {published data only}
  • Wang Q, Li AL, Zhi DS, Huang HL. Effect of mild hypothermia on glucose metabolism and glycerol of brain tissue in patients with severe traumatic brain injury. Chinese Journal of Traumatology 2007;10(4):246-9.
Wusi 2006 {published data only}
  • Wusi Q, Hong S, Ying Z, Weimin W, Weiguo L, Qizhou J, et al. Noninvasive selective brain cooling by head and neck cooling is protective in severe traumatic brain injury. Journal of Clinical Neuroscience 2006;13:995-1000.
Xia 2005 {published data only}
  • Xia YQ, Yan LL, Xu RX, Wang QH. Evaluation of improvement of subhypothermia in cerebral vasospasm after severe craniocerebral injury. Chinese Journal of Clinical Rehabilitation 2005;9(41):138-41.
Yamagami 1997 {published data only}
  • Yamagami K, Iwase M, Matsubara M, Matsuo N, Tanaka T. Nitric oxide production and arginine consumption in traumatic brain injury are correlated with severity. Abstracts of the 26th Meeting of the Society for Critical Care Medicine. Critical Care Medicine. 1997; Vol. 25, issue supplement 1:A72.
Yan 2007 {published data only}
  • Yan Y, Tang W, He J, Gao J, Dan W, Zhong D, et al. Clinical research about brain oxygen metabolism and neuroelectrophysiology during mild hypothermia in patients with severe head injury. Chinese Journal of Surgery 2007;45(2):109-13.
Zhi 2003 {published data only}

References to ongoing studies

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Adelson 2007 {unpublished data only}
  • Pediatric traumatic brain injury consortium: hypothermia.. Ongoing study November 2007.
Beca 2006 {unpublished data only}
  • Pilot Study of Early and Prolonged Hypothermia in Severe Traumatic Brain Injury in Children.. Ongoing study November 2006.
Clifton 2002 {unpublished data only}
  • National Acute Brain Injury Study: Hypothermia II (NABISH II).. Ongoing study 4/1/02 - 6/30/08.
Maekawa 2002 {unpublished data only}
  • Therapeutic Strategy for Severe Head Trauma Patients With Mild Hypothermia and Estimation of Medical Expenses in Japan.. Ongoing study December 2002.

Additional references

  1. References to studies included in this review
  2. References to studies excluded from this review
  3. References to ongoing studies
  4. Additional references
Adelson 2003
  • Adelson PD, Bratton SL, Carney NA, Chestnut RM, Coudray HEM, Goldstein B, Kochanek PM, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents. Pediatric critical care medicine 2003;4(3 (Suppl)):S1-75. [DOI: ]
Adelson 2008a
  • Adelson D. [Personal communication with author]. 5 October 2008.
Adelson 2008b
  • Adelson D. [Personal communication with author]. 17 October 2008.
Adelson 2009
Bering 1961
  • Bering EA Jr. Effect of body temperature change on cerebral oxygen consumption of the intact monkey. American Journal of Physiology 1961;200:417-9.
Bullock 1996
  • Bullock R, Chesnut RM, Clifton G, Ghajar J, Marion DW, Narayan RK, et al. Guidelines for the management of severe head injury. Journal of Neurotrauma 1996;13:639-734.
Bullock 2007
  • Bullock MR, Povlishock JT. Guidelines for the management of severe head injury. Journal of Neurotrauma 2007;24(Supplement 1):S1-106. [DOI: ]
Busto 1987
  • Busto R, Dietrich WD, Globus MY, Valdes I, Scheinberg P, Ginsberg MD. Small differences in intra-ischemic brain temperature critically determine the extent of ischemic neuronal injury. Journal of Cerebral Blood Flow Metabolism 1987;7:729-38.
Busto 1989
  • Busto R, Globus MY, Dietrich WD, Martinez E, Valdes I, Ginsberg MD. Effect of mild hypothermia on ischemia-induced release of neuro-transmitters and free fatty acids in rat brain. Stroke 1989;20:904-10.
Clasen 1968
Clifton 1995
Clifton 2009
Fay 1945
  • Fay T. Observations on generalized refrigeration in cases of severe cerebral trauma. Assoc Res Nerv Ment Dis Proc 1945;24:611-9.
Higgins 2008
  • Higgins JPT, Green S (editors). The Cochrane Handbook of Systematic Reviews. The Cochrane Collaboration 2008; Vol. Version 5.0.0 [updated February 2008]:Available from www.cochrane-handbook.org.
Kirkpatrick 1997
Langlois 2006
Laskowski 1960
Peterson 2008
Polderman 2008
Review Manager (RevMan)
  • The Nordic Cochrane Center. Review Manager (RevMan). 5.0.0. Copenhagen: The Cochrane Collaboration, 2008.
Schubert 1995
Sedzimir 1959
Shapiro 1974
Smith 1996
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