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Randomized Controlled Trial of Long-term Mild Hypothermia for Severe Traumatic Brain Injury (LTH-Ⅰ)

The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Listing a study does not mean it has been evaluated by the U.S. Federal Government. Read our disclaimer for details.
 
ClinicalTrials.gov Identifier: NCT01886222
Recruitment Status : Completed
First Posted : June 25, 2013
Last Update Posted : March 12, 2020
Sponsor:
Collaborators:
First Affiliated Hospital of Zhejiang University
West China Hospital
Second Affiliated Hospital of Wenzhou Medical University
The 101st Hospital of Chinese People's Liberation Army
The 98 Hospital of People's Liberation Army
Shenzhen Second People's Hospital
The 94 Hospital of People's Liberation Army
Nanfang Hospital of Southern Medical University
The Affiliated Hospital of Medical College of Chinese People's Armed Police Forces
Xiangya Hospital of Central South University
Taizhou First People's Hospital
Tang-Du Hospital
Qilu Hospital of Shandong University
Chongqing Emergency Medical Center
Xuzhou Central Hospital
The Affiliated Hospital Of Southwest Medical University
Information provided by (Responsible Party):
Jiyao Jiang, RenJi Hospital

Brief Summary:

This study is a prospective multi-centre randomized trial to compare the effect of long-term mild hypothermia versus routine normothermic intensive management in patients with severe traumatic brain injury.

The primary hypothesis is that the induction of mild hypothermia (maintained at 34-35℃) for 5 days will improve the outcome of patients at six months post injury compared with normothermia.


Condition or disease Intervention/treatment Phase
Brain Injuries Craniocerebral Trauma Other: Long-term mild hypothermia Other: Normothermia Not Applicable

Detailed Description:

Traumatic brain injury (TBI) remains a leading cause of death and disability in people with injuries and constitutes a major public health concern both in developed and developing countries. There are multiple clinical trials of hypothermia therapy for TBI conducted, however, with conflicting results. Subgroup analysis of most meta-analysis showed that therapeutic effect was significant when hypothermia was maintained more than 48 hours. We have previously reported a multicenter trial of mild hypothermia (33-35℃) for severe traumatic brain injury, in which 215 patients was randomized to long-term mild hypothermia group (n = 108) for 5 ±1.3 days mild hypothermia therapy and short-term mild hypothermia group ( n = 107) for 2±0.6 days mild hypothermia therapy. The results shown improved outcomes in patients with long-term mild hypothermia and similar frequency of complications. Therefore we concluded that long-term hypothermia, which maintains at 33-35℃ for 5 days, could be considered in the management of severe traumatic brain injury.

Hypothermia therapy was recommend as the level III evidence by the 2007 Brain Trauma Foundation's guideline and this treatment is currently used in our department and other large neurosurgical centers across China, with the aim to decrease the high intracranial pressure (ICP) and improve the functional outcome of TBI patients. When the decision was made, the injured patients would be placed on cooling blankets, tracheotomized and ventilated. The patients would receive continuous infusions of a paralytic drug (Tracrium 10-40 mg/hour) and chlorpromazine (5-10 mg/hour) administered using an infusion pump to prevent shivering. The dosage was given according to each patient's temperature, blood pressure, heart rate, and muscular tone. Once the patient's rectal temperature reached 33˚C, it was kept at approximately that temperature (33-35˚C) 5 to 7 days. Then the patients were passively rewarmed to a temperature of 37 to 38˚C at a rate no greater than 1˚C/hour, by gradual adjustment of the blanket thermostat.

The present multi-center, randomized controlled trials is designed to investigate the efficacy and safety of long-term (5 days) mild hypothermia versus normothermia on the outcome of patients following severe traumatic brain injury. The primary outcome is the neurological function assessed at 1, 6 months post injury with the Glasgow Outcome Score (GOS). Additionally, the following data will also be recorded and compared: the baseline data, Glasgow Coma Score,imaging examination (e.g. CT scan), need of surgery, intracranial pressure, laboratory tests (e.g. blood routine test, liver and kidney function, blood gas analysis, etc), the complications (e.g. pneumonia, significant bleeding) and so on.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 312 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Double (Investigator, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: A Multi-center, Randomized, Controlled Trial to Evaluate the Efficacy and Safety of Long-term Mild Hypothermia in Adult Patients With Severe Traumatic Brain Injury
Actual Study Start Date : November 12, 2013
Actual Primary Completion Date : June 30, 2019
Actual Study Completion Date : June 30, 2019

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Long-term mild hypothermia
Focused intervention
Other: Long-term mild hypothermia
Hypothermia will be induced within 6 hours of injury and maintained at 34-35℃ for 5 days.Then the patients will be passively rewarmed to a temperature of 36 to 37˚C at a rate no greater than 0.5˚C/4 hours.
Other Name: Mild hypothermia therapy

Normothermia
Standard management
Other: Normothermia
Patients assigned to the normothermia group will be kept at 36-37℃.




Primary Outcome Measures :
  1. Neurological function [ Time Frame: 6 months post injury ]
    The neurological function will be evaluated at 6 months post injury by a specialized investigator who is unaware of the patients' allocation according to five-category Glasgow Outcome Scale as follows: 1, death; 2, vegetative state - unable to interact with the environment; 3, severe disability - unable to live independently but able to follow commands; 4, moderate disability - capable of living independently but unable to return to work or school; and 5, good recovery - able to return to work or school.


Secondary Outcome Measures :
  1. Intracranial pressure (ICP) control [ Time Frame: Admission, day 1, day 2, day 3, day 4, day 5, day 6, day 7, day 14, or until the monitor is removed ]
    The effect of long-term hypothermia on ICP control will be determined.

  2. Glasgow Coma Score (GCS) [ Time Frame: Admission, day 1, day 2, day 3, day 4, day 5, day 6, day 7, day 14, day 21, day 28 post injury ]
    The neurological function improvement during study intervention will be evaluated.

  3. Length of ICU stay [ Time Frame: 6 months post injury ]
    The numbers of days in the ICU.

  4. Length of hospital stay [ Time Frame: 6 months post injury ]
    The numbers of days in the hospital.

  5. Frequency of complications [ Time Frame: 6 months post injury ]
    Frequency of complications during the the study such as pneumonia, significant bleeding, liver and kidney function abnormality will be recorded and compared between groups.

  6. Mortality rate [ Time Frame: 6 months post injury ]
    The proportion of death will be determined at 6 months post injury.



Information from the National Library of Medicine

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Ages Eligible for Study:   18 Years to 65 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age 18 - 65 years within 6 hours post injury;
  • Closed head injury;
  • Glasgow Coma Scale(GCS) score 4 to 8 after resuscitation;
  • The intracranial pressure is more than 25 mmHg;
  • Cerebral contusion on computed tomographic scan.

Exclusion Criteria:

  • GCS of 3 with bilateral fixed and dilated pupils;
  • A life-threatening injury to an organ other than the brain;
  • No spontaneous breathing or cardiac arrest at the scene of the injury;
  • No consent;
  • Pregnancy.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01886222


Locations
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China, Shanghai
Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University
Shanghai, Shanghai, China, 200127
Sponsors and Collaborators
RenJi Hospital
First Affiliated Hospital of Zhejiang University
West China Hospital
Second Affiliated Hospital of Wenzhou Medical University
The 101st Hospital of Chinese People's Liberation Army
The 98 Hospital of People's Liberation Army
Shenzhen Second People's Hospital
The 94 Hospital of People's Liberation Army
Nanfang Hospital of Southern Medical University
The Affiliated Hospital of Medical College of Chinese People's Armed Police Forces
Xiangya Hospital of Central South University
Taizhou First People's Hospital
Tang-Du Hospital
Qilu Hospital of Shandong University
Chongqing Emergency Medical Center
Xuzhou Central Hospital
The Affiliated Hospital Of Southwest Medical University
Investigators
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Principal Investigator: Jiyao Jiang, MD, PhD Department of Neurosurgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, China
Additional Information:
Publications:
Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):
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Responsible Party: Jiyao Jiang, Professor, RenJi Hospital
ClinicalTrials.gov Identifier: NCT01886222    
Other Study ID Numbers: RJNS001
First Posted: June 25, 2013    Key Record Dates
Last Update Posted: March 12, 2020
Last Verified: March 2020
Keywords provided by Jiyao Jiang, RenJi Hospital:
Traumatic brain injury
Additional relevant MeSH terms:
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Brain Injuries
Brain Injuries, Traumatic
Craniocerebral Trauma
Hypothermia
Wounds and Injuries
Brain Diseases
Central Nervous System Diseases
Nervous System Diseases
Trauma, Nervous System
Body Temperature Changes