Brain Cooling Proved Effective in Treatment Of Head Trauma

February 19, 1997

PITTSBURGH, Feb. 19 -- Moderate cooling of the brain is the first new treatment shown to be effective for severe brain trauma, according to University of Pittsburgh Medical Center (UPMC) researchers who believe this finding will change the way such cases are treated in the crucial first hours after injury. The study is published in this week's New England Journal of Medicine (NEJM). More than a dozen previous trials of various medications have failed to show benefit for brain trauma patients.

Investigators from the UPMCs Brain Trauma Research Center found that inducing moderate hypothermia -- lowering the body temperature from the normal range of 37-38o C (98-99o F) to 32-33o C (87-88o F) -- for 24 hours after patients suffer severe traumatic brain injury led to improved patient outcomes (less disability and better recovery) for these patients when compared with those who did not receive the treatment. The standard measure of mental responsiveness is the Glasgow Coma Scale, developed to assess coma by determining motor, verbal and eye-response to stimulus.

Among all participants, good outcomes were achieved by 56 percent of hypothermia patients compared with 33 percent of the patients treated conventionally; mortality rates were 20 percent among those who had received hypothermia treatment and 24 percent in the other patients.

In a subset of patients who showed some brain activity despite unconsciousness at the time of admission (Glasgow Coma Scale 5, 6 or 7, amounting to 61 percent of those in the study), the results were even more dramatic. At six months after their injuries, 73 percent of patients receiving hypothermia treatment had a good outcome (moderate to no disability) compared with 35 percent of patients in the control group. Mortality was also markedly improved in this group of patients: 9 percent in the hypothermia group, 23 percent in the non-hypothermia group. UPMC researchers believe that hypothermia produces improved outcomes in two ways: by reducing swelling due to inflammation and by inhibiting the cascade of neurochemicals (especially glutamate) that kill brain cells.

Principal investigator Donald W. Marion, M.D., associate professor of neurosurgery and chief, neurotrauma service, department of neurological surgery at the UPMC, commented, This study is significant because it verifies the effectiveness of this treatment after more than 15 studies of other therapies proved ineffective. Now, more people who suffer non-penetrating head trauma may be able to resume a normal life. Hypothermia treatment delivered within six hours of trauma is relatively simple and inexpensive to implement and free of unwanted side effects.

Severe brain trauma is a common cause of death and mental impairment, particularly among young people. Annually, 50,000 people suffer such injuries and require long-term care at a cost of more than $20 billion, according to the National Institute of Neurological Disorders and Stroke (NINDS). Motor vehicle accidents are the most common cause of such injuries. Gunshot and other penetrating wounds were an exclusionary factor for this study.

The study, which ran from February 1991 through September 1994, screened 155 patients brought to the UPMC Trauma Department whose injuries left them unresponsive to verbal commands. The 82 patients who met the pre-determined entry criteria were randomly assigned to hypothermia or non-hypothermia groups within six hours of injury.

Patients who received hypothermia were placed in a special bed with cooling blankets connected to pumps that provided continuous circulation of icy water. In addition, patients were cooled by a catheter through the nose to the stomach (nasogastric iced salt water lavage).

Acute care of patients followed the principles described in "Guidelines for the Management of Severe Head Injuries," including surgical reduction of pressure on the brain by swelling in the cranium by removal of large blood clots, halting hemorrhaging and removal of tissue that has died.

After 24-hours of therapy, the patients' body temperatures were gradually increased, one degree per hour.

This research was supported by a grant from the NINDS.

The UPMC also is participating in further studies of this treatment through a national multi-center trial. Future research plans of the UPMC Brain Trauma Research Center include studies of new pharmacological agents combined with hypothermia.

Results from pilot studies, including a September 1993 report by Dr. Marion published in the Journal of Neurosurgery, were so promising that last year Health and Human Services Secretary Donna Shalala waived the usual requirement for obtaining consent from a relative of each (unresponsive) patient before being able to enroll them in the study.

Other authors of the NEJM article include Louis E. Penrod, M.D., Sheryl F. Kelsey, Ph.D., Walter D. Obrist, Ph.D., Patrick M. Kochanek, M.D., Alan M. Palmer, Ph.D., Stephen R. Wisniewski, Ph.D., and Steven T. DeKosky, M.D.

University of Pittsburgh Medical Center

Related Brain Articles from Brightsurf:

Glioblastoma nanomedicine crosses into brain in mice, eradicates recurring brain cancer
A new synthetic protein nanoparticle capable of slipping past the nearly impermeable blood-brain barrier in mice could deliver cancer-killing drugs directly to malignant brain tumors, new research from the University of Michigan shows.

Children with asymptomatic brain bleeds as newborns show normal brain development at age 2
A study by UNC researchers finds that neurodevelopmental scores and gray matter volumes at age two years did not differ between children who had MRI-confirmed asymptomatic subdural hemorrhages when they were neonates, compared to children with no history of subdural hemorrhage.

New model of human brain 'conversations' could inform research on brain disease, cognition
A team of Indiana University neuroscientists has built a new model of human brain networks that sheds light on how the brain functions.

Human brain size gene triggers bigger brain in monkeys
Dresden and Japanese researchers show that a human-specific gene causes a larger neocortex in the common marmoset, a non-human primate.

Unique insight into development of the human brain: Model of the early embryonic brain
Stem cell researchers from the University of Copenhagen have designed a model of an early embryonic brain.

An optical brain-to-brain interface supports information exchange for locomotion control
Chinese researchers established an optical BtBI that supports rapid information transmission for precise locomotion control, thus providing a proof-of-principle demonstration of fast BtBI for real-time behavioral control.

Transplanting human nerve cells into a mouse brain reveals how they wire into brain circuits
A team of researchers led by Pierre Vanderhaeghen and Vincent Bonin (VIB-KU Leuven, Université libre de Bruxelles and NERF) showed how human nerve cells can develop at their own pace, and form highly precise connections with the surrounding mouse brain cells.

Brain scans reveal how the human brain compensates when one hemisphere is removed
Researchers studying six adults who had one of their brain hemispheres removed during childhood to reduce epileptic seizures found that the remaining half of the brain formed unusually strong connections between different functional brain networks, which potentially help the body to function as if the brain were intact.

Alcohol byproduct contributes to brain chemistry changes in specific brain regions
Study of mouse models provides clear implications for new targets to treat alcohol use disorder and fetal alcohol syndrome.

Scientists predict the areas of the brain to stimulate transitions between different brain states
Using a computer model of the brain, Gustavo Deco, director of the Center for Brain and Cognition, and Josephine Cruzat, a member of his team, together with a group of international collaborators, have developed an innovative method published in Proceedings of the National Academy of Sciences on Sept.

Read More: Brain News and Brain Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to