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Brain cooling after head trauma 'does not improve outcomes'

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A new Australian study casts fresh doubt on the controversial practice of brain cooling in the wake of a traumatic head injury, concluding it does not improve outcomes for patients.

The study, published in the Journal of the American Medical Association, shows people who undergo brain cooling have the same ability to live independently as patients managed with their brain at normal temperature.

“Hypothermia management had no effect on patients’ outcomes”

Jamie Cooper

Cooling the body and brain – or hypothermia – is a technique that has been used for decades for patients with traumatic brain injury in an effort to decrease inflammation and swelling and hopefully boost the chances of recovery.

While clinical studies and guidance flag up the benefits, there are ongoing concerns about the quality of research, cost of treatment and potential complications.

This latest study, unveiled at the annual meeting of the European Society of Intensive Care Medicine in Paris, involved 511 people with traumatic brain injury from six different countries.

Known as the POLAR trial, it is the largest randomised trial conducted to date looking at the impact of hypothermia.

Researchers found the percentage of patients able to live independently six months following brain trauma was the same whether or not brain cooling was used in their treatment.

Death rates at six months were just over 21% in the group who received hypothermia, compared with 18.4% in those with a normal temperature target.

Adjusting the data for the severity of the brain injury and different patient groups made no difference to the results.

The study was led by Professor Jamie Cooper, director of the Australian and New Zealand Intensive Care Research Centre in Melbourne.

“Hypothermia management had no effect on patients’ outcomes, but it did increase complications – including decreased heart rate, decreased blood pressure, and increased pneumonia,” he explained.

He claimed that the findings had finally resolved the debate about the benefits of brain cooling and called for guidelines to be changed.

“The POLAR trial has finally resolved a generation-old controversy and teaches clinicians that the best temperature target after brain trauma is the normal one, not the cool one,” he said.

“The high quality research is now clear that hypothermia is not beneficial so international guidelines should recommend against using it,” he added.

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