ROANOKE TIMES
Copyright (c) 1997, Roanoke Times
DATE: Thursday, February 20, 1997 TAG: 9702200041
SECTION: NATL/INTL PAGE: A-6 EDITION: METRO
DATELINE: NEW YORK
SOURCE: Associated Press
Victims of severe brain injuries can recover faster and perhaps more fully if their bodies are chilled to 87 or 88 degrees for a day, a study found.
The cooling treatment is ``something every hospital could do,'' said Dr. Donald Marion, director of the brain trauma research center at the University of Pittsburgh Medical Center. ``It's not high-tech.''
Marion and his colleagues reported their findings in Thursday's issue of the New England Journal of Medicine.
More than 370,000 Americans a year are hospitalized with brain injuries. The cooling strategy, called hypothermia, is used now in some brain injury patients, but not widely.
The researchers studied 82 patients who were in comas after traffic accidents, falls, assaults or other incidents. All received standard treatment, but half were also cooled for 24 hours, starting an average of 10 hours after the injury.
Their body temperatures were lowered by putting special cooling blankets above and below them. The blankets, standard equipment at hospitals, had cold water circulating in them. In some patients, cold water was injected into the stomach through a nose or mouth tube.
The patients were given drugs to keep them from shivering.
Patients who had started out in the worst shape - some of them nearly brain dead - were not helped by the cooling. But patients who had started out better off - those, for example, who moved their arms and legs in response to pain during their comas - did benefit.
Six months after being injured, 73 percent of the patients who had been cooled were able to live independently, vs. 35 percent of the other patients.
A year after injury, the results were about the same. But for statistical reasons the difference was less convincing, the researchers said.
At the least, the study proves that the cooling treatment speeds up recovery, Marion said. That's a benefit when one considers the economic and social costs of a brain injury. He also said the treatment is safe.
It's not clear why it works, but one possibility involves a brain substance called glutamate that rises to toxic levels after an injury. The cooling reduced glutamate levels in patients who benefited from the treatment.
The cooling might also suppress harmful inflammation in the brain after injury. The researchers found that the treatment reduced levels of a substance called interleukin-1-beta that plays a role in the inflammatory response.
Dr. Randall Chesnut, an associate professor of neurosurgery at the Oregon Health Sciences University, said the evidence strongly suggests that chilling the body makes a difference.
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