Noninvasive selective brain cooling by head and neck cooling is protective in severe traumatic brain injury

Therapeutic hypothermia is a promising treatment for patients with severe traumatic brain injury (TBI). We present here the results of a study in which noninvasive selective brain cooling (SBC) was achieved using a head cap and neckband. Ninety patients with severe TBI were divided into a normothermia control group (n = 45) and a SBC group (n = 45), whose brain temperature was maintained at 33-35 degrees C for 3 days using a combination of head and neck cooling. At 24, 48 and 72 h after injury, the mean intracranial pressure (ICP) values of the patients who underwent SBC were lower than those of the normothermia controls (19.14 +/- 2.33, 19.72 +/- 1.73 and 17.29 +/- 2.07 mmHg, versus 23.41 +/- 2.51, 20.97 +/- 1.86, and 20.13 +/- 1.87 mmHg, respectively, P < 0.01). There was a significant difference in the neurological recovery of the two groups at the 6-month follow-up after TBI. Good neurological outcome (Glasgow Outcome Scale score of 4 to 5) rates 6 months after injury were 68.9% for the SBC group, and 46.7% for the control group (P < 0.05). There were no complications resulting in severe sequelae. In conclusion, the noninvasive SBC described here is a safe method of administering therapeutic hypothermia, which can reduce ICP and improve prognosis without severe complications in patients with severe TBI. (c) 2006 Elsevier Ltd. All rights reserved.