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Cooling the brain following traumatic brain injury not proven helpful

Cooling the brain after a traumatic brain injury may not help improve neurological outcomes and might even increase mortality. That's the conclusion of a randomized trial of 225 children with brain injuries.  However,the study researches suspect that by changing the cooling and re-warming protocol, other researchers may have more success with this therapy.

The study was designed to see if the neurological outcome improved in children whose brains were cooled following severe brain damage. The results published in the June 5 issue of the New England Journal of Medicine found that there was no difference in outcome between those whose brains were cooled and those who received standard treatment. Additionally, the researchers saw a trend toward increased mortality in the cooled group.

Youngsters up to age 4 are among those most likely to suffer a traumatic brain injury, according to the U.S. Centers for Disease Control and Prevention. About 435,000 American children visit emergency rooms with traumatic brain injuries each year, and as many as 2,685 children die from traumatic brain injuries in the United States annually, according to the CDC.

One of the study authors, Dr. Jamie Hutchison, suggested that there may be a number of reasons why they didn't see an effect from cooling in the current trial.  "Possibly, we may need to keep it going longer after a brain injury, because the brain keeps swelling for days after an injury. Perhaps 24 hours is too short a duration" Also, he said that there was a significantly higher incidence of low blood pressure during re-warming, and that the re-warming period may have been too quick.

The bottom line, said Hutchison, is that cooling for brain injury in children should not be used in the same context it was for this trial: 24 hours of cooling with re-warming occurring over 18 hours.

More work is taking place in other research centers to determine how helpful brain cooling is in improving the outcome in children who have sustained traumatic brain damage.



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