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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Saturday, November 7, 2015


St. Emlyn´s - November 7, 2015 by Dan Horner 
"October has been a stellar month for publication of critical care trials in high impact journals. SPLIT, HEAT and FELLOW have already been FOAMed all over, but that left me with a still tempting choice of EUROTHERM 3235 and EPO-TBI. Given we recruited to the former here in Virchester I thought it would only be polite to give this large undertaking some additional time in the spotlight. After all, the European Society of Intensive Care Medicine did call it “ the most important clinical trial in critical care ever…”, a bold statement if ever I have read one. You’ll have to read the protocol if you want the full quote….
What’s it all about then?
Well, when it comes to neuronal cell death and attenuation of the inflammatory cascade, we in the intensive care unit seem very keen to cool things down. Papers have been published describing the rationale for this therapy, including the EUROTHERM trial protocol if you want to brush up on the pathphysiology. How cool, for how long and in what conditions will complications outweigh benefits all remain key questions. There have been recent lessons from TTM in the case of cardiac arrest but a parallel area where the jury remains out has been the role of therapeutic hypothermia (TH) for neuroprotection following traumatic brain injury. Earlier small studies have led to a position of equipoise. Some centres are using regularly as an adjunct for refractory ICP control, others are more cautious and have asked for further evidence. People often have very strong (dogmatic) opinions either way.
This study aimed to address the equipoise through conduct of a large, multi-centre randomised controlled trial. As always, the full article and accompanying supplementary appendix make good reading and I urge you to have a look at all the data for yourself..."