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Harris B, Andrews PJD, Murray GD, et al. Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke. Southampton (UK): NIHR Journals Library; 2012 Nov. (Health Technology Assessment, No. 16.45.)

Cover of Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke

Systematic Review of Head Cooling in Adults After Traumatic Brain Injury and Stroke.

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Appendix 9Information for members of the public

Head-cooling therapy after brain injury

You are being invited to read and comment on the following information because our research team is interested in the views of members of the public.

Brain injury and cooling

Patients who have suffered a brain injury, for example from an accident or a stroke, often have a raised temperature. This may increase damage from the injury and contribute to swelling in the brain, which can increase damage further still. It is usual to give these patients cooling therapy to try and restore their temperature to normal. If brain swelling is a particular problem, patients may be cooled to below normal temperature (hypothermia therapy).

The usual cooling therapies include drugs, such as paracetamol, washing with cool water and machines that circulate cold water through pads or blankets applied to the body. These therapies reduce the temperature of the whole body. But for some time it has been thought that it could be helpful to apply cooling to the head alone. This targets the site of the injury and may reduce the side effects of cooling the entire body, particularly when temperature is reduced to below normal.

Head cooling is already being successfully used in babies who suffer brain damage from lack of oxygen at birth. The problem with applying cooling to the head in adults is that it may not have enough effect on brain temperature to be helpful. Head cooling is therefore not yet part of normal care in adults and is still being researched.

Head-cooling research to date

We have recently reviewed the research evidence on head cooling in brain injury to assess the current state of knowledge. The patients who received head cooling in these research studies were very ill – unconscious and sedated – and had their brain temperature measured as part of their normal care. Two main methods of head cooling were used:

  • delivery of cooling gas through the nose
  • helmets with cold water circulating through the lining.

On the next page there are photos of these methods.

Side effects from the cooling methods were generally minor and got better after cooling stopped. They included whitening of the nose from cold and small areas of skin damage.

Head cooling reduced brain temperature by at least 1 °C within about 1 hour, which may be potentially helpful. However, the research so far does not provide information on whether patients recover better from their injuries as a result of head cooling. That is the real measure of effectiveness of any treatment.

Further research

In summary, we know that head cooling can reduce brain temperature but we do not yet know enough about its effects on recovery to use it as part of normal care. Further research is needed to assess this. Because this kind of research is done when people are very sick, they are not able to give their own consent to take part in the research. Some people have a welfare guardian who can give permission on their behalf, but otherwise a close family member is asked. The delay in finding someone to give permission can mean that the person cannot take part in the research at all. In England a doctor who is involved in the patient’s care, but who is not involved in the research, can give permission. It is possible that the law will be changed in Scotland to allow this.

Any comments you may have about head-cooling therapy and research, including the issue of permission, will be very much appreciated.

© 2012, Crown Copyright.

Included under terms of UK Non-commercial Government License.

Bookshelf ID: NBK127491

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