Prolonged Therapeutic Hypothermia After Traumatic Brain Injury in Adults

Data Synthesis Twelve trials met eligibility criteria and were included in the analysis. We also performed subanalyses by different hypothermia interventions (ie, depth, du- ration, and rapidity of rewarming after hypothermia) and methodological quality. Thera- peutic hypothermia was associated with a 19% reduction in the risk of death (95% con- fidenceinterval(CI),0.69-0.96)anda22%reductionintheriskofpoorneurologicoutcome (95% CI, 0.63-0.98) compared with normothermia. Hypothermia longer than 48 hours was associated with a reduction in the risks of death and of poor neurologic outcome (relative risk (RR), 0.70; 95% CI, 0.56-0.87 and RR, 0.65; 95% CI, 0.48-0.89, respec- tively) compared with normothermia. Hypothermia to a target temperature between 32°C and 33°C, a duration of 24 hours, and rewarming within 24 hours were all asso- ciated with reduced risks of poor neurologic outcome compared with normothermia. Assessment of methodological quality did not reveal evidence of bias.