POLAR Study Revisited: Therapeutic Hypothermia in Severe Brain Trauma Should Not Be Abandoned

Oláh, E; Pótó, László; Rumbus, Zoltán; Pákai, Eszter; Romanovsky, Andrej A.; Hegyi, Péter; Garami, András

doi:10.1089/neu.2020.7509

Cited by 6 publications

(5 citation statements)

References 31 publications

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“…Similarly to cold, severe systemic inflammation (e.g., severe sepsis) can be also accompanied by decreased core body temperature (called as hypothermia), which is associated with higher mortality in human patients [ 32 ]. It should be also noted that, in contrast with the spontaneously developing hypothermia in the cold or in systemic inflammation, the induction of hypothermia can be used as a therapeutic intervention to improve the outcome of diseases, such as severe traumatic brain injury [ 33 ]. Regardless of its etiology, the decreased tissue temperature greatly influences biochemical processes, thereby also vascular reactions.…”

Section: Discussionmentioning

confidence: 99%

Stereolithography 3D Printing of a Heat Exchanger for Advanced Temperature Control in Wire Myography

et al. 2022

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We report the additive manufacturing of a heat-exchange device that can be used as a cooling accessory in a wire myograph. Wire myography is used for measuring vasomotor responses in small resistance arteries; however, the commercially available devices are not capable of active cooling. Here, we critically evaluated a transparent resin material, in terms of mechanical, structural, and thermal behavior. Tensile strength tests (67.66 ± 1.31 MPa), Charpy impact strength test (20.70 ± 2.30 kJ/m2), and Shore D hardness measurements (83.0 ± 0.47) underlined the mechanical stability of the material, supported by digital microscopy, which revealed a glass-like structure. Differential scanning calorimetry with thermogravimetry analysis and thermal conductivity measurements showed heat stability until ~250 °C and effective heat insulation. The 3D-printed heat exchanger was tested in thermophysiology experiments measuring the vasomotor responses of rat tail arteries at different temperatures (13, 16, and 36 °C). The heat-exchange device was successfully used as an accessory of the wire myograph system to cool down the experimental chambers and steadily maintain the targeted temperatures. We observed temperature-dependent differences in the vasoconstriction induced by phenylephrine and KCl. In conclusion, the transparent resin material can be used in additive manufacturing of heat-exchange devices for biomedical research, such as wire myography. Our animal experiments underline the importance of temperature-dependent physiological mechanisms, which should be further studied to understand the background of the thermal changes and their consequences.

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Section: Discussionmentioning

confidence: 99%

Stereolithography 3D Printing of a Heat Exchanger for Advanced Temperature Control in Wire Myography

et al. 2022

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“…For example, some scholars randomly divided 148 children with TBI into TH and normal temperature treatment groups at a ratio of 2:1. After a 6-month of follow-up visits and treatment, no significant difference was found in the Glasgow outcome scale (GOS) scores and mortality between the two groups of patients (29,30). Thus, this treatment method requires further research.…”

Section: Discussionmentioning

confidence: 99%

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

et al. 2022

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Background: Therapeutic hypothermia (TH) is effective to treat adult traumatic brain injury (TBI), but there is still controversy about its safety to treat the children with severe TBI.Methods: Clinical studies on TH in children with severe TBI from January 2000 to September 2020 were screened in PubMed, Web of Science, Embase, Cochrane Library, Nature, NCKI, and Wanfang online databases. Data were meta-analyzed by Rev Man 5.3. Differences in mortality, adverse outcomes, duration of Pediatric Intensive Care Unit (PICU), incidence of infection, and incidence of arrhythmia were compared between experimental group and control group. The heterogeneity of the results was evaluated by chi-square test and I 2 test in Rev Man 5.3, and publication bias was evaluated by funnel plot.Results: Five articles were included, including 421 children. Cochrane evaluation was B grade or above, and Jadad scale score was over three points. The overall mortality between two groups showed great difference

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“…As independent factors, milder and longer cooling, and rewarming at <0.25°C /h were associated with better outcomes [78]. A cooling index-based meta-analysis, including the recent POLAR-ACT study, strengthened the results regarding the benefits of TH [83].…”

Section: Sydenham [63] 2009 23 1614mentioning

confidence: 92%

“…Several studies have previously reported on the quality of RCTs, with results showing that lowquality RCTs overestimate the benefits of TH, while high-quality RCTs showed no difference in outcome between the TH and the normothermia groups, or even worse outcomes in the TH group [63,68,69,78,79,81,83]. Indeed, two RCTs with a low risk of bias [31,32] showed significantly higher mortality, poorer outcomes, and an equal incidence of new-onset pneumonia in the TH group.…”

Section: Review Of Prior Meta-analysesmentioning

confidence: 99%

Therapeutic Hypothermia for Severe Traumatic Brain Injury: an Overviews of Reviews and Future Prospects

Kobata

2024

Preprint

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Fever control is essential in patients with severe traumatic brain injury (TBI). The efficacy of therapeutic hypothermia (TH) in severe TBI has been investigated over the last few decades; however, in contrast to experimental studies showing benefits, no evidence of efficacy has been demonstrated in clinical practice. In this review, the mechanisms and history of hypothermia were briefly outlined, while the results of major randomized controlled trials (RCTs) and meta-analyses investigating TH for adult TBI are introduced and discussed. The retrieved meta-analyses showed conflicting results, with a limited number of studies indicating benefits of TH. Some studies have shown benefits of long-term TH compared with short-term TH. Although TH is effective at lowering elevated intracranial pressure (ICP), reduced ICP does not lead to favorable outcomes. Low-quality RCTs overestimated the benefits of TH, while high-quality RCTs showed no difference or worse outcomes with TH. RCTs assessing standardized TH quality demonstrated the benefits of TH. As TBI has heterogeneous and complicated pathologies, applying a uniform treatment may not be ideal. A meta-analysis of young patients who underwent early cooling and hematoma removal showed better TH results. TH should not be abandoned, and its optimal should be advocated on an individual basis.

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POLAR Study Revisited: Therapeutic Hypothermia in Severe Brain Trauma Should Not Be Abandoned

Cited by 6 publications

References 31 publications

Stereolithography 3D Printing of a Heat Exchanger for Advanced Temperature Control in Wire Myography

Stereolithography 3D Printing of a Heat Exchanger for Advanced Temperature Control in Wire Myography

Effects of therapeutic hypothermia on the safety of children with severe traumatic brain injury: a systematic review and meta-analysis

Therapeutic Hypothermia for Severe Traumatic Brain Injury: an Overviews of Reviews and Future Prospects

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