Is brain cooling after a traumatic brain injury beneficial for patients?

Written by Alice Bough, Future Science Group

Scientists from Monash University (Melbourne, Australia) and colleagues from across the world have performed a study to determine if brain cooling is beneficial for patients with traumatic brain injuries (TBIs). The study, which took place over an 8-year period (2010–2018), has the potential to change the way TBI is treated in the clinic.
The paper, which has been published in the Journal of the American Medical Association, and presented at the 2018 Congress of European Society of Intensive Care Medicine (20–24 October, Paris, France), utilizes data collected during the Prophylactic hypOthermia trial to Lessen trAumatic bRain injury (POLAR) trial. This randomized-controlled trial with 511 participants investigated whether reduction of brain temperature in patients with TBI was beneficial.

This year, approximately 50–60 million individuals worldwide will suffer a TBI. Currently, brain cooling is a common treatment option for the injury. It is believed that cooling reduces inflammation in the brain and consequently reduces the risk of permanent brain damage.

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In the POLAR study, the outcomes of patients who received hypothermic treatment in response to TBI were compared with the outcomes of patients who received standard normothermic management. For patients receiving hypothermic treatment, cooling was achieved by intravenous cold saline when in the ambulance followed by use of cold body wraps on arrival at the intensive care unit or emergency department.

“There was no benefit to patients receiving hypothermia, as measured by their capacity to live independently following recovery from the TBI with 49% able to do so in both groups,” commented Jamie Cooper (Monash University), one of the lead authors on the paper. Cooper believes that “this study is the final word on whether hypothermia as a treatment for TBI works.”

There are many risks associated with brain cooling, for example, there is an increased risk of infection and patients experience a decrease in heart rate and blood pressure. “From now on, patients should not have to endure the risks of hypothermia because we now know there are no benefits,” stated Cooper.

Sources: Cooper DJ, Nichol AD, Bailey M et al. Effect of early sustained prophylactic hypothermia on neurological outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial. J. Am. Med. Assoc. (2018) (Epub ahead of print); EurekAlert. Landmark study reveals no benefit to costly and risky brain cooling after brain injury. Press release: www.eurekalert.org