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No benefit from hypothermia in management of liver failure

In patients with acute liver failure, controlled moderate hypothermia could not limit the development of brain swelling as was suggested by previous studies, according to new data published in the Journal of Hepatology.

“In this randomized controlled trial of targeted temperature management in patients with acute liver failure at high risk of cerebral edema and intracranial hypertension, we found that management of patients with a target body temperature at 34°C as compared to 36°C was not associated with a lower incidence of clinically significant elevations in intracranial pressure,” William Bernal, MD, at Kings College Hospital in London, and colleagues wrote. “These findings were unexpected and contrary to those suggested by animal models of acute liver failure, where moderate hypothermia appears extremely effective in prevention of intracranial hypertension and in the reduction of its severity when it develops.”

Animal models and human case series of acute liver failure suggested that moderate hypothermia can protect against brain swelling, the researchers wrote. To evaluate this finding, Bernal and colleagues performed a prospective randomized controlled trial.

The researchers assessed 43 patients with acute liver failure, high-grade encephalopathy and intracranial pressure. The researchers administered 72 hours of targeted temperature management to each patient either at 34°C, as part of the moderate hypothermia group (n = 17), or at 36°C, as part of the control group (n = 26).

The primary outcome was sustained elevation in intracranial pressure above 25 mmHg. Secondary outcomes were the occurrence of pre-defined serious adverse events, magnitude of intracranial pressure elevations and all-cause hospital mortality.

The researchers found no significant difference between the two groups in the primary outcome. Overall, 35% of the moderate hypothermia group had swelling vs. 27% in the control group. Further, the incidence of adverse events and overall mortality was 41% in the moderate hypothermia group and 46% in the control group.

The researchers concluded that this study did not confirm any advantage of moderate hypothermia in treating these patients.

“Moderate hypothermia can be induced rapidly and without the use of specialist cooling devices but precise control of low temperature may be challenging,” the researchers wrote. “Our clinical impression is thus that the use of these lower temperatures is not justified for intracranial hypertension prevention, though they may continue to be utilized as short-term rescue therapy in patients with refractory intracranial hypertension or potentially in other specific clinical settings.” – by Will Offit

Disclosure: The researchers report no relevant financial disclosures.