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OTTAWA, June 10, 2003 - Inducing hypothermia for patients with traumatic brain injuries (TBI) decreases mortality and poor neurological outcomes, according to a group of Canadian researchers lead by Dr. Lauralyn McIntyre of the Ottawa Hospital Research Institute. Their findings are published in the June 11, 2003 edition of the Journal of the American Medical Association (JAMA).
Traumatic brain injury (TBI) is the result of a blow to the head or spinning forces on the brain. Common causes include motor vehicle crashes, falls or assaults. June is Brain Injury Awareness Month, and according to the organizers of the campaign, 30 Canadians die every day from a traumatic brain injury*.
When a patient suffers a traumatic brain injury, damage occurs at different stages. First, there is the initial trauma to the brain. Then, secondary damage comes from swelling and other complications that follow. For instance, substances released in the brain as a result of the injury can worsen the existing injury. Lack of oxygen and low blood pressure can also worsen the injury.
Some researchers believe hypothermia helps by slowing down the metabolic rate in the brain to a rate that the body can provide appropriate oxygen for. Others believe it helps counteract the swelling and the damage that this causes. Some believe in a combination of the two, or in other physiological benefits.
Although there is still some debate in how hypothermia counteracts the negative effects of brain injuries, this research concludes that it probably does. In addition, researchers concluded some important details about the cooling.
"Our team has concluded that when a patient is cooled for more than 48 hours, there is a reduced risk of both death and of a poor neurological outcome," said Dr. McIntyre, who is also an intensivist at The Ottawa Hospital. "We also concluded that these patients do better if they are induced into moderate hypothermia, between 32°C and 33°C, for a period of 24 hours, and if they are rewarmed to normal body temperature within 24 hours of the end of cooling."
While the scope of our study was not large enough to recommend a universal change of practice immediately, "it does indicate the need for a randomized clinical trial to evaluate the possibility of changing the way we manage these patients," said Dr. McIntyre, who enthusiastically hopes to lead such a trial.
Canadian researchers are very active in the investigation of hypothermia as a means to reduce the impact of brain injuries, and several important studies are currently underway to determine its effectiveness in both adults and children.
About the Ottawa Hospital Research Institute:
The OHRI is the research arm of The Ottawa Hospital and a major part of the University of Ottawa Faculty of Medicine and Faculty of Health Sciences. With more than 200 scientists, 225 students and 400 support staff, and $45 million in external funding, the OHRI is one of the fastest growing and most respected hospital-based research institutes in Canada.
*Source: http://www.biam.ca/about.htm
Ron Vezina
Manager, Public Affairs and Media Relations
The Ottawa Hospital
(613) 737-8460.