Efficacy of hypothermia intervention on adult severe craniocerebral injury: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Qi , YUAN Lili , DING Xianhui ,  ZHOU Zhiming

Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu 241001, P.R.China;

Corresponding author：

ZHOU Zhiming, Email: neuro_depar@hotmail.com

Keywords：

Hypothermia; Mild hypothermia; Severe craniocerebral injury; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202003106

Video：

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Objectives To systematically review the efficacy of hypothermia intervention on adult severe craniocerebral injury.Methods CNKI, WanFang Data, VIP, CBM, PubMed, EMbase, Web of Science and The Cochrane Library databases were electronically searched to collect randomized controlled trials (RCTs) of hypothermia intervention on severe craniocerebral injury from the establishment of the database to July 2^nd, 2020.Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies, then, meta-analysis was performed by using RevMan 5.3 software.Results A total of 25 RCTs involving 2 949 patients were included. The results of meta-analysis showed that the mortality of hypothermia intervention group was lower than that of normal body temperature group (RR=0.72, 95%CI 0.58 to 0.89, P=0.003), and the prognosis of hypothermia intervention group was better than that of normal body temperature group (RR=1.29, 95%CI 1.15 to 1.46, P<0.000 1).Conclusions Current evidence shows that the hypothermia intervention has a lower mortality rate and a higher prognosis rate in the treatment of adult severe brain injury. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.

Citation： WANG Qi, YUAN Lili, DING Xianhui, ZHOU Zhiming. Efficacy of hypothermia intervention on adult severe craniocerebral injury: a meta-analysis. Chinese Journal of Evidence-Based Medicine, 2020, 20(10): 1180-1186. doi: 10.7507/1672-2531.202003106 Copy

1.	Baguley I, Slewa-Younan S, Lazarus R, et al. Long-term mortality trends in patients with traumatic brain injury. Brain Inj, 2000, 14(6): 505-512.
2.	江龙建, 钱忠心. 亚低温疗法在急性重症颅脑损伤中的临床应用. 同济大学学报(医学版), 2001, (04): 53-55.
3.	郭伟, 王莉莉, 蔡坤皓, 等. 亚低温治疗重度颅脑损伤68例对照研究. 新乡医学院学报, 2004, (04): 269-271.
4.	陈飞, 邵高峰, 何玉领, 等. 亚低温治疗重型颅脑损伤的应用价值. 浙江临床医学, 2008, (05): 592-593.
5.	江基尧, 方乃成, 张建平, 等. 亚低温治疗重型颅脑损伤前瞻性临床多中心对照研究. 上海第二医科大学学报, 2005, (03): 270-272.
6.	潘仁龙. 亚低温在重型颅脑损伤患者中的应用. 中国危重病急救医学, 2004, (11): 650.
7.	韩广明. 亚低温治疗急性重型颅脑损伤42例临床研究. 河北医学, 2004, 10(11): 990-992.
8.	吴全理, 罗大山, 韩方华, 等. 亚低温治疗重型颅脑损伤的疗效观察. 广西医科大学学报, 1999, (05): 3-5.
9.	张凯. 探讨亚低温脑保护在创伤性颅脑损伤治疗中的临床应用效果. 中国伤残医学, 2018, 26(24): 45-46.
10.	顾克繁. 亚低温治疗急性重度颅脑损伤100例临床疗效观察. 牡丹江医学院学报, 2015, 36(6): 56-58.
11.	顾召军. 用亚低温疗法治疗急性重型颅脑损伤的效果分析. 当代医药论丛, 2018, 16(2): 9-11.
12.	康健, 李胜龙, 杨金坤, 等. 亚低温治疗重型颅脑损伤的临床效果. 中国实用医药, 2016, 11(3): 96-97.
13.	蓝欢, 周志宇, 李光, 等. 亚低温治疗重型颅脑损伤的临床疗效观察. 微创医学, 2015, 10(6): 833-835, 851.
14.	刘慧丽. 亚低温治疗重型颅脑损伤的临床疗效及安全性评价. 中国继续医学教育, 2016, 8(22): 63-65.
15.	王军, 董举峰, 马金福. 64例重型颅脑损伤亚低温治疗疗效观察. 世界最新医学信息文摘, 2019, 19(49): 83-84.
16.	王廉, 张成, 姜壮, 等. 亚低温治疗重型颅脑损伤的疗效观察. 临床医学研究与实践, 2016, 1(16): 58.
17.	易辉. 亚低温治疗重型颅脑损伤患者临床疗效观察及安全性评价. 临床医学, 2016, 36(3): 33-35.
18.	Clifton GL, Valadka A, Zygun D, et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol, 2011, 10(2): 131-139.
19.	Harris OA, Muh CR, Surles MC, et al. Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial. Neurosurg, 2009, 110(6): 1256-1264.
20.	Hashiguchi N, Shiozaki T, Ogura H, et al. Mild hypothermia reduces expression of heat shock protein 60 in leukocytes from severely head-injured patients. Trauma, 2003, 55(6): 1054-1060.
21.	Liu WG, Qiu WS, Zhang Y, et al. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. Int Med Res, 2006, 34(1): 58-64.
22.	Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl Med, 1997, 336(8): 540-546.
23.	Shiozaki T, Hayakata T, Taneda M, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. Neurosurg, 2001, 94(1): 50-54.
24.	Cooper DJ, Nichol AD, Bailey M, et al. Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial. JAMA, 2018, 320(21): 2211-2220.
25.	Hifumi T, Kuroda Y, Kawakita K, et al. Fever control management is preferable to mild therapeutic hypothermia in traumatic brain injury patients with abbreviated injury scale 3-4: a multi-center, randomized controlled trial. J Neurotrauma, 2016, 33(11): 1047-1053.
26.	Andrews PJ, Sinclair HL, Rodríguez A, et al. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: The Eurotherm 3 235 RCT. Health Technol Assess, 2018, 22(45): 1-134.
27.	Shafi NI, Mariscalco MM. Considering the use of induced hypothermia in a pediatric patient with traumatic brain injury: a critical appraisal of two meta-analyses. Pediatr Crit Care Med, 2006, 7(5): 468-472.
28.	Presneill J, Gantner D, Nichol A, et al. Statistical analysis plan for the POLAR-RCT: the prophylactic hypothermia trial to lessen traumatic brain injury-randomised controlled trial. Trials, 2018, 19(1): 259.
29.	孙前进, 梁岩. 易损斑块的研究进展. 医学综述, 2009, 15(4): 560-565.
30.	杜光勇, 贺淑禹, 纪文军, 等. 亚低温治疗对重型颅脑损伤后上消化道出血的影响. 中国临床神经外科杂志, 2012, 17(2): 116-117.
31.	Crompton EM, Lubomirova I, Cotlarciuc I, et al. Meta-analysis of therapeutic hypothermia for traumatic brain injury in adult and pediatric patients. Crit Care Med, 2017, 45(4): 575-583.
32.	Chen H, Wu F, Yang P, et al. A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care, 2019, 23(1): 396.
33.	Zhu Y, Yin H, Zhang R, et al. Therapeutic hypothermia versus normothermia in adult patients with traumatic brain injury: a meta-analysis. Springerplus, 2016, 5(1): 801.
34.	Dietrich WD, Bramlett HM. The evidence for hypothermia as a neuroprotectant in traumatic brain injury. Neurotherapeutics, 2010, 7(1): 43-50.
35.	Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26(3): 311-315.
36.	Sandestig A, Romner B, Grände PO. Therapeutic hypothermia in children and adults with severe traumatic brain injury. Ther Hypothermia Temp Manag, 2014, 4(1): 10-20.
37.	Algattas H, Huang JH. Traumatic brain injury pathophysiology and treatments: early, intermediate, and late phases post-injury. Int J Mol Sci, 2013, 15(1): 309-341.
38.	Locci E, Noto A, Puddu M, et al. A longitudinal 1H-NMR metabolomics analysis of urine from newborns with hypoxic-ischemic encephalopathy undergoing hypothermia therapy. Clinical and medical legal insights. PLoS One, 2018, 13(4): e0194267.
39.	Biancolini CA, Del Bosco CG, Jorge MA, et al. Active core rewarming in neurologic, hypothermic patients: effects on oxygen-related variables. Crit Care Med, 1993, 21(8): 1164-1168.
40.	宋向奇. 亚低温治疗对重型颅脑损伤疗效及安全性的系统评价. 唐山: 华北理工大学, 2015.
41.	Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet, 2008, 371(9628): 1955-1969.
42.	Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury Ⅲ. Prophylactic hypothermia. J Neurotrauma, 2007, 24(Suppl 1): S21-S25.
43.	李志刚, 姬喜荣, 郑太祖, 等. 长时程亚低温与短时程亚低温治疗重型颅脑损伤的比较研究. 中华危重病急救医学, 2019, 31(12): 1440-1444.
44.	Rosomoff HL. The effects of hypothermia on the physiology of the nervous system. Surgery, 1956, 40(2): 328-336.
45.	Rosomoff HL, Holaday DA. Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol, 1954, 179(1): 85-88.
46.	McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. JAMA, 2003, 289(22): 2992-2999.

1. Baguley I, Slewa-Younan S, Lazarus R, et al. Long-term mortality trends in patients with traumatic brain injury. Brain Inj, 2000, 14(6): 505-512.
2. 江龙建, 钱忠心. 亚低温疗法在急性重症颅脑损伤中的临床应用. 同济大学学报(医学版), 2001, (04): 53-55.
3. 郭伟, 王莉莉, 蔡坤皓, 等. 亚低温治疗重度颅脑损伤68例对照研究. 新乡医学院学报, 2004, (04): 269-271.
4. 陈飞, 邵高峰, 何玉领, 等. 亚低温治疗重型颅脑损伤的应用价值. 浙江临床医学, 2008, (05): 592-593.
5. 江基尧, 方乃成, 张建平, 等. 亚低温治疗重型颅脑损伤前瞻性临床多中心对照研究. 上海第二医科大学学报, 2005, (03): 270-272.
6. 潘仁龙. 亚低温在重型颅脑损伤患者中的应用. 中国危重病急救医学, 2004, (11): 650.
7. 韩广明. 亚低温治疗急性重型颅脑损伤42例临床研究. 河北医学, 2004, 10(11): 990-992.
8. 吴全理, 罗大山, 韩方华, 等. 亚低温治疗重型颅脑损伤的疗效观察. 广西医科大学学报, 1999, (05): 3-5.
9. 张凯. 探讨亚低温脑保护在创伤性颅脑损伤治疗中的临床应用效果. 中国伤残医学, 2018, 26(24): 45-46.
10. 顾克繁. 亚低温治疗急性重度颅脑损伤100例临床疗效观察. 牡丹江医学院学报, 2015, 36(6): 56-58.
11. 顾召军. 用亚低温疗法治疗急性重型颅脑损伤的效果分析. 当代医药论丛, 2018, 16(2): 9-11.
12. 康健, 李胜龙, 杨金坤, 等. 亚低温治疗重型颅脑损伤的临床效果. 中国实用医药, 2016, 11(3): 96-97.
13. 蓝欢, 周志宇, 李光, 等. 亚低温治疗重型颅脑损伤的临床疗效观察. 微创医学, 2015, 10(6): 833-835, 851.
14. 刘慧丽. 亚低温治疗重型颅脑损伤的临床疗效及安全性评价. 中国继续医学教育, 2016, 8(22): 63-65.
15. 王军, 董举峰, 马金福. 64例重型颅脑损伤亚低温治疗疗效观察. 世界最新医学信息文摘, 2019, 19(49): 83-84.
16. 王廉, 张成, 姜壮, 等. 亚低温治疗重型颅脑损伤的疗效观察. 临床医学研究与实践, 2016, 1(16): 58.
17. 易辉. 亚低温治疗重型颅脑损伤患者临床疗效观察及安全性评价. 临床医学, 2016, 36(3): 33-35.
18. Clifton GL, Valadka A, Zygun D, et al. Very early hypothermia induction in patients with severe brain injury (the National Acute Brain Injury Study: Hypothermia II): a randomised trial. Lancet Neurol, 2011, 10(2): 131-139.
19. Harris OA, Muh CR, Surles MC, et al. Discrete cerebral hypothermia in the management of traumatic brain injury: a randomized controlled trial. Neurosurg, 2009, 110(6): 1256-1264.
20. Hashiguchi N, Shiozaki T, Ogura H, et al. Mild hypothermia reduces expression of heat shock protein 60 in leukocytes from severely head-injured patients. Trauma, 2003, 55(6): 1054-1060.
21. Liu WG, Qiu WS, Zhang Y, et al. Effects of selective brain cooling in patients with severe traumatic brain injury: a preliminary study. Int Med Res, 2006, 34(1): 58-64.
22. Marion DW, Penrod LE, Kelsey SF, et al. Treatment of traumatic brain injury with moderate hypothermia. N Engl Med, 1997, 336(8): 540-546.
23. Shiozaki T, Hayakata T, Taneda M, et al. A multicenter prospective randomized controlled trial of the efficacy of mild hypothermia for severely head injured patients with low intracranial pressure. Mild Hypothermia Study Group in Japan. Neurosurg, 2001, 94(1): 50-54.
24. Cooper DJ, Nichol AD, Bailey M, et al. Effect of early sustained prophylactic hypothermia on neurologic outcomes among patients with severe traumatic brain injury: the POLAR randomized clinical trial. JAMA, 2018, 320(21): 2211-2220.
25. Hifumi T, Kuroda Y, Kawakita K, et al. Fever control management is preferable to mild therapeutic hypothermia in traumatic brain injury patients with abbreviated injury scale 3-4: a multi-center, randomized controlled trial. J Neurotrauma, 2016, 33(11): 1047-1053.
26. Andrews PJ, Sinclair HL, Rodríguez A, et al. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: The Eurotherm 3 235 RCT. Health Technol Assess, 2018, 22(45): 1-134.
27. Shafi NI, Mariscalco MM. Considering the use of induced hypothermia in a pediatric patient with traumatic brain injury: a critical appraisal of two meta-analyses. Pediatr Crit Care Med, 2006, 7(5): 468-472.
28. Presneill J, Gantner D, Nichol A, et al. Statistical analysis plan for the POLAR-RCT: the prophylactic hypothermia trial to lessen traumatic brain injury-randomised controlled trial. Trials, 2018, 19(1): 259.
29. 孙前进, 梁岩. 易损斑块的研究进展. 医学综述, 2009, 15(4): 560-565.
30. 杜光勇, 贺淑禹, 纪文军, 等. 亚低温治疗对重型颅脑损伤后上消化道出血的影响. 中国临床神经外科杂志, 2012, 17(2): 116-117.
31. Crompton EM, Lubomirova I, Cotlarciuc I, et al. Meta-analysis of therapeutic hypothermia for traumatic brain injury in adult and pediatric patients. Crit Care Med, 2017, 45(4): 575-583.
32. Chen H, Wu F, Yang P, et al. A meta-analysis of the effects of therapeutic hypothermia in adult patients with traumatic brain injury. Crit Care, 2019, 23(1): 396.
33. Zhu Y, Yin H, Zhang R, et al. Therapeutic hypothermia versus normothermia in adult patients with traumatic brain injury: a meta-analysis. Springerplus, 2016, 5(1): 801.
34. Dietrich WD, Bramlett HM. The evidence for hypothermia as a neuroprotectant in traumatic brain injury. Neurotherapeutics, 2010, 7(1): 43-50.
35. Zhao QJ, Zhang XG, Wang LX. Mild hypothermia therapy reduces blood glucose and lactate and improves neurologic outcomes in patients with severe traumatic brain injury. J Crit Care, 2011, 26(3): 311-315.
36. Sandestig A, Romner B, Grände PO. Therapeutic hypothermia in children and adults with severe traumatic brain injury. Ther Hypothermia Temp Manag, 2014, 4(1): 10-20.
37. Algattas H, Huang JH. Traumatic brain injury pathophysiology and treatments: early, intermediate, and late phases post-injury. Int J Mol Sci, 2013, 15(1): 309-341.
38. Locci E, Noto A, Puddu M, et al. A longitudinal 1H-NMR metabolomics analysis of urine from newborns with hypoxic-ischemic encephalopathy undergoing hypothermia therapy. Clinical and medical legal insights. PLoS One, 2018, 13(4): e0194267.
39. Biancolini CA, Del Bosco CG, Jorge MA, et al. Active core rewarming in neurologic, hypothermic patients: effects on oxygen-related variables. Crit Care Med, 1993, 21(8): 1164-1168.
40. 宋向奇. 亚低温治疗对重型颅脑损伤疗效及安全性的系统评价. 唐山: 华北理工大学, 2015.
41. Polderman KH. Induced hypothermia and fever control for prevention and treatment of neurological injuries. Lancet, 2008, 371(9628): 1955-1969.
42. Brain Trauma Foundation, American Association of Neurological Surgeons, Congress of Neurological Surgeons, et al. Guidelines for the management of severe traumatic brain injury Ⅲ. Prophylactic hypothermia. J Neurotrauma, 2007, 24(Suppl 1): S21-S25.
43. 李志刚, 姬喜荣, 郑太祖, 等. 长时程亚低温与短时程亚低温治疗重型颅脑损伤的比较研究. 中华危重病急救医学, 2019, 31(12): 1440-1444.
44. Rosomoff HL. The effects of hypothermia on the physiology of the nervous system. Surgery, 1956, 40(2): 328-336.
45. Rosomoff HL, Holaday DA. Cerebral blood flow and cerebral oxygen consumption during hypothermia. Am J Physiol, 1954, 179(1): 85-88.
46. McIntyre LA, Fergusson DA, Hébert PC, et al. Prolonged therapeutic hypothermia after traumatic brain injury in adults: a systematic review. JAMA, 2003, 289(22): 2992-2999.

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Efficacy of hypothermia intervention on adult severe craniocerebral injury: a meta-analysis

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