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.	江龍建, 錢忠心. 亞低溫療法在急性重癥顱腦損傷中的臨床應用. 同濟大學學報(醫學版), 2001, (04): 53-55.
3.	郭偉, 王莉莉, 蔡坤皓, 等. 亞低溫治療重度顱腦損傷68例對照研究. 新鄉醫學院學報, 2004, (04): 269-271.
4.	陳飛, 邵高峰, 何玉領, 等. 亞低溫治療重型顱腦損傷的應用價值. 浙江臨床醫學, 2008, (05): 592-593.
5.	江基堯, 方乃成, 張建平, 等. 亞低溫治療重型顱腦損傷前瞻性臨床多中心對照研究. 上海第二醫科大學學報, 2005, (03): 270-272.
6.	潘仁龍. 亞低溫在重型顱腦損傷患者中的應用. 中國危重病急救醫學, 2004, (11): 650.
7.	韓廣明. 亞低溫治療急性重型顱腦損傷42例臨床研究. 河北醫學, 2004, 10(11): 990-992.
8.	吳全理, 羅大山, 韓方華, 等. 亞低溫治療重型顱腦損傷的療效觀察. 廣西醫科大學學報, 1999, (05): 3-5.
9.	張凱. 探討亞低溫腦保護在創傷性顱腦損傷治療中的臨床應用效果. 中國傷殘醫學, 2018, 26(24): 45-46.
10.	顧克繁. 亞低溫治療急性重度顱腦損傷100例臨床療效觀察. 牡丹江醫學院學報, 2015, 36(6): 56-58.
11.	顧召軍. 用亞低溫療法治療急性重型顱腦損傷的效果分析. 當代醫藥論叢, 2018, 16(2): 9-11.
12.	康健, 李勝龍, 楊金坤, 等. 亞低溫治療重型顱腦損傷的臨床效果. 中國實用醫藥, 2016, 11(3): 96-97.
13.	藍歡, 周志宇, 李光, 等. 亞低溫治療重型顱腦損傷的臨床療效觀察. 微創醫學, 2015, 10(6): 833-835, 851.
14.	劉慧麗. 亞低溫治療重型顱腦損傷的臨床療效及安全性評價. 中國繼續醫學教育, 2016, 8(22): 63-65.
15.	王軍, 董舉峰, 馬金福. 64例重型顱腦損傷亞低溫治療療效觀察. 世界最新醫學信息文摘, 2019, 19(49): 83-84.
16.	王廉, 張成, 姜壯, 等. 亞低溫治療重型顱腦損傷的療效觀察. 臨床醫學研究與實踐, 2016, 1(16): 58.
17.	易輝. 亞低溫治療重型顱腦損傷患者臨床療效觀察及安全性評價. 臨床醫學, 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.	孫前進, 梁巖. 易損斑塊的研究進展. 醫學綜述, 2009, 15(4): 560-565.
30.	杜光勇, 賀淑禹, 紀文軍, 等. 亞低溫治療對重型顱腦損傷后上消化道出血的影響. 中國臨床神經外科雜志, 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, Gr?nde 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. 亞低溫治療對重型顱腦損傷療效及安全性的系統評價. 唐山: 華北理工大學, 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.	李志剛, 姬喜榮, 鄭太祖, 等. 長時程亞低溫與短時程亞低溫治療重型顱腦損傷的比較研究. 中華危重病急救醫學, 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. 江龍建, 錢忠心. 亞低溫療法在急性重癥顱腦損傷中的臨床應用. 同濟大學學報(醫學版), 2001, (04): 53-55.
3. 郭偉, 王莉莉, 蔡坤皓, 等. 亞低溫治療重度顱腦損傷68例對照研究. 新鄉醫學院學報, 2004, (04): 269-271.
4. 陳飛, 邵高峰, 何玉領, 等. 亞低溫治療重型顱腦損傷的應用價值. 浙江臨床醫學, 2008, (05): 592-593.
5. 江基堯, 方乃成, 張建平, 等. 亞低溫治療重型顱腦損傷前瞻性臨床多中心對照研究. 上海第二醫科大學學報, 2005, (03): 270-272.
6. 潘仁龍. 亞低溫在重型顱腦損傷患者中的應用. 中國危重病急救醫學, 2004, (11): 650.
7. 韓廣明. 亞低溫治療急性重型顱腦損傷42例臨床研究. 河北醫學, 2004, 10(11): 990-992.
8. 吳全理, 羅大山, 韓方華, 等. 亞低溫治療重型顱腦損傷的療效觀察. 廣西醫科大學學報, 1999, (05): 3-5.
9. 張凱. 探討亞低溫腦保護在創傷性顱腦損傷治療中的臨床應用效果. 中國傷殘醫學, 2018, 26(24): 45-46.
10. 顧克繁. 亞低溫治療急性重度顱腦損傷100例臨床療效觀察. 牡丹江醫學院學報, 2015, 36(6): 56-58.
11. 顧召軍. 用亞低溫療法治療急性重型顱腦損傷的效果分析. 當代醫藥論叢, 2018, 16(2): 9-11.
12. 康健, 李勝龍, 楊金坤, 等. 亞低溫治療重型顱腦損傷的臨床效果. 中國實用醫藥, 2016, 11(3): 96-97.
13. 藍歡, 周志宇, 李光, 等. 亞低溫治療重型顱腦損傷的臨床療效觀察. 微創醫學, 2015, 10(6): 833-835, 851.
14. 劉慧麗. 亞低溫治療重型顱腦損傷的臨床療效及安全性評價. 中國繼續醫學教育, 2016, 8(22): 63-65.
15. 王軍, 董舉峰, 馬金福. 64例重型顱腦損傷亞低溫治療療效觀察. 世界最新醫學信息文摘, 2019, 19(49): 83-84.
16. 王廉, 張成, 姜壯, 等. 亞低溫治療重型顱腦損傷的療效觀察. 臨床醫學研究與實踐, 2016, 1(16): 58.
17. 易輝. 亞低溫治療重型顱腦損傷患者臨床療效觀察及安全性評價. 臨床醫學, 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. 孫前進, 梁巖. 易損斑塊的研究進展. 醫學綜述, 2009, 15(4): 560-565.
30. 杜光勇, 賀淑禹, 紀文軍, 等. 亞低溫治療對重型顱腦損傷后上消化道出血的影響. 中國臨床神經外科雜志, 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, Gr?nde 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. 亞低溫治療對重型顱腦損傷療效及安全性的系統評價. 唐山: 華北理工大學, 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. 李志剛, 姬喜榮, 鄭太祖, 等. 長時程亞低溫與短時程亞低溫治療重型顱腦損傷的比較研究. 中華危重病急救醫學, 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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