Therapeutic Hypothermia: not a panacea

If hypothermia protects the brain, maybe we should use it for anyone who is at risk of brain injury during acute illness? Fortunately other potential uses of hypothermia are being investigated, such as this:  Mourvillier B, Tubach F, van de Beek D, et al.: Induced hypothermia in severe bacterial meningitis: A randomized clinical trial. JAMA 2013:-

100 comatose adults with meningitis were randomized to either cooling to 33.5 degrees or not. The study was stopped early as there seemed to be more deaths in the hypothermia patients. The early stopping could be criticized as the p-value was only 0.04 at that point, but it is always a difficult decision to stop early for a very serious potential complication, do you go on and confirm the complication but have more patients suffer, or continue and find that it was just a statistical fluke, or stop the study and risk being inconclusive, which means the included patients have not been able to contribute to the body of knowledge which was why they volunteered in the first place.

Anyway final analysis shows that the difference in death was non-significantly increased after correcting for other factors. The authors analyzed their data as best they could and concluded that there was very little likelihood that cooling was beneficial.

So it looks like we should avoid it in meningitis, and it is quite uncertain in brain trauma. Acute global hypoxia/ischemia in adults and term newborns is the only clinical situation where it is proven to improve outcomes. Before we start using it for necrotising enterocolitis, for example,  we need the kind of scrupulous study that the French multi-center group did for meningitis… and we need to figure out stopping rules first.

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About keithbarrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
This entry was posted in Neonatal Research and tagged , . Bookmark the permalink.

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