UMEM Educational Pearls

Category: Critical Care

Title: Hypothermia for Severe Traumatic Brain Injury

Keywords: Critical care, Trauma, TBI, ICP, hypothermia (PubMed Search)

Posted: 12/22/2015 by Daniel Haase, MD
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The EuroTherm3235 Trial was a randomized, multi-center trial to study hypothermia (32-35oC) in severe, traumatic brain injury1:

  • Hypothermia was compared with hyperosmolar therapies (hypertonic saline and mannitol) as "Stage 2" management.
  • While hypothermia did successfully reduce ICP, functional outcomes (as measured in Extended Glasgow Outcome Score [GCS-E]) trended towards harm at six months (though not significantly different).
  • Take-home: The study design has significant flaws, but the lack of clear benefit of hypothermia is consistent with previous studies2 and suggests that fever prevention or controlled normothermia (36oC) may be ideal for severe TBI patients, but needs further study.


1. Andrews PJ, Sinclair HL, et al; Eurotherm3235 Trial Collaborators. Hypothermia for Intracranial Hypertension after Traumatic Brain Injury. N Engl J Med. 2015 Dec 17;373(25):2403-12. doi: 10.1056/NEJMoa1507581. Epub 2015 Oct 7. PubMed PMID: 26444221.

2. Brain Trauma Foundation; American Association of Neurological Surgeons; Congress of Neurological Surgeons. Guidelines for the management of severe traumatic brain injury. J Neurotrauma. 2007;24 Suppl 1:S1-106. PubMed PMID: 17511534.