Introduction: Hypothermia has been resurrected for brain protection in cardiac arrest. It has been suggested to not be efficacious for traumatic brain injury. We examined the hypothesis of time versus depth of hypothermia

Methods: Patients admitted with non-penetrating head trauma, with glasgow scores of 8 or less were evaluated for entry . Exclusionary criteria included no space occupying lesion > 30cc, by CT, no operative systemic trauma,ICP< 10 at presentation, Patients all received standard resuscitation,using hypertonic saline, intubation,and ICP (camino).Entry criteria was ICP .20 at four hours of resuscitation,and normal lab values.Patients were placed in hypothermia 32-34 Celsius for five days,using neuromuscular blockade, sedation and pain medications.Every five days rewarming was attempted,if ICP was less than 18 torr. If ICP remained less than twenty patient was rewarmed, but if ICP elevated, patient was returned to hypothermia for five days.This cycle was continued until ICP was controlled during rewarming at < 18 torr.

Results: Seventeen patients were treated, with a hypothermic state range of 15-35 days.Patients were evaluated by PM&R services, and cared for after transfer by their team. End point Functional Independence measure(FIM) scores ranged from 60 to 108,avg. 85

Conclusions: Prolonged hypothermia may be a useful savage tool for refractory intracranial hypertension following trauma.This is related to the time line of the multifactorial chemical cascade in trauma.

Patient Care: It appears to have improved functional outcomes in severely injured brain trauma patients.

Learning Objectives: Discuss Refractory Intracranial pressure criteria Understand the pro inflammatory and chemical cascade reputed to be active in traumatic brain injury Be able to apply and maintain the physiologic needs of patients in prolonged hypothermia Discuss cost benefit issues related to this therapy

References: Advanced Life Support Task Force #71-0260 Marion,D, et.al. NEJM 336(8) Feb 1997 540-546