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Archives of Academic Emergency Medicine

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Vol. 14 No. 1 (2026)

October 2025

Mild Hypothermia Versus Normothermia During Barbiturate Coma Therapy After Severe Traumatic Brain Injury: Protocol for a Random-ized Controlled Trial

  • Alireza Motamedi
  • Mojtaba Mohammadzadeh Lame
  • Firooz Salehpour
  • Sima Zohrabi
  • Leila Nikniaz
  • Ata Mahmoodpoor
  • Hadi Hamishehkar
  • Saeed Pirmoradi
  • Robab Mehdizadeh Esfanjani
  • Maryam Soleimanpour
  • Amir Vahedi
  • Reza Javadrashid
  • Hassan Soleimanpour

Archives of Academic Emergency Medicine, Vol. 14 No. 1 (2026), 1 October 2025 , Page e52
https://doi.org/10.22037/aaem.v14i1.3054 Published: 2026-09-10

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Abstract

Introduction: Severe traumatic brain injury (TBI) is a leading cause of death and long-term disability worldwide. Therapeutic hypothermia may lower intracranial pressure (ICP) and reduce metabolic demand. This study aims to compare mild therapeutic hypothermia with controlled normothermia in adult TBI patients undergoing Barbiturate Coma Therapy (BCT), and to explore artificial intelligence (AI)-assisted prognostic models. Methods: This single-center, pilot, parallel-group randomized trial evaluates the feasibility and safety of adding mild hypothermia to BCT and explores early signals of benefit or harm. The primary outcome, six-month Glasgow Outcome Scale–Extended (GOSE), is reported descriptively with exact 95% confidence intervals. Secondary outcomes include Cerebral Performance Category, mortality, duration of mechanical ventilation and vasopressor use, intensive care unit (ICU)/hospital length of stay, complications, and physiological/laboratory trends. An exploratory AI-assisted substudy (using prospectively collected clinical, radiological, physiological, and laboratory data) applies LASSO regression to admission predictors of six-month unfavorable outcome and mortality.

Keywords:
  • Brain Injuries
  • Traumatic; Hypothermia
  • Induced
  • Glasgow Outcome Scale
  • Prognosis
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How to Cite

1.
Motamedi A, Mohammadzadeh Lame M, Salehpour F, Zohrabi S, Nikniaz L, Mahmoodpoor A, et al. Mild Hypothermia Versus Normothermia During Barbiturate Coma Therapy After Severe Traumatic Brain Injury: Protocol for a Random-ized Controlled Trial. Arch Acad Emerg Med [Internet]. 2026 Sep. 10 [cited 2026 Sep. 27];14(1):e52. Available from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/3054
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References

1. Maas AIR, Menon DK, Adelson PD, Andelic N, Bell MJ, Belli A, et al. Traumatic brain injury: integrated approaches to improve prevention, clinical care, and research. Lancet Neu-rol. 2017;16(12):987-1048.

2. James SL, Theadom A, Ellenbogen RG, Bannick MS, Mont-joy-Venning W, Lucchesi LR, et al. Global, regional, and na-tional burden of traumatic brain injury and spinal cord inju-ry, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(1):56-87.

3. Soleimanpour H. Implementation of therapeutic hypo-thermia in medicine. Hauppauge (NY): Nova Science Pub-lishers;2025. p. 91-95.

4. Afsar E, Sadeghi-Bazargani H, Salehpour F, Bihamta A, Sanaie S, Tatli M, et al. Impact of epidemiological and nutri-tional factors on outcomes following traumatic brain injury in a prospective cohort study. Sci Rep. 2026;16(1):25836.

5. Werner C, Engelhard K. Pathophysiology of traumatic brain injury. Br J Anaesth. 2007;99(1):4-9.

6. Carney N, Totten AM, O'Reilly C, Ullman JS, Hawryluk GW, Bell MJ, et al. Guidelines for the management of severe trau-matic brain injury, fourth edition. Neurosurgery. 2017;80(1):6-15.

7. Lavinio A, Coles JP, Robba C, Aries M, Bouzat P, Chean D, et al. Targeted temperature control following traumatic brain injury: ESICM/NACCS best practice consensus recommenda-tions. Crit Care. 2024;28(1):170.

8. Stocchetti N, Maas AI. Traumatic intracranial hyperten-sion. N Engl J Med. 2014;370(22):2121-30.

9. Chesnut RM, Temkin N, Carney N, Dikmen S, Rondina C, Videtta W, et al. A trial of intracranial-pressure monitoring in traumatic brain injury. N Engl J Med. 2012;367(26):2471-81.

10. Gharizadeh N, Ghojazadeh M, Naseri A, Dolati S, Tarighat F, Soleimanpour H. Hypertonic saline for traumatic brain in-jury: a systematic review and meta-analysis. Eur J Med Res. 2022;27(1):254.

11. Hawryluk GW, Rubiano AM, Totten AM, O’Reilly C, Ullman JS, Bratton SL, et al. Guidelines for the management of severe traumatic brain injury:2020 update of the decom-pressive craniectomy recommendations. Neurosurgery. 2020;87(3):427-34.

12. Jo KW. Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention. Acute Crit Care. 2022;37(4):483-90.

13. Dietrich WD, Bramlett HM. Therapeutic hypothermia and targeted temperature management in traumatic brain injury: clinical challenges for successful translation. Brain Res. 2016;1640:94-103.

14. Dietrich WD, Bramlett HM. Therapeutic hypothermia and targeted temperature management for traumatic brain inju-ry: experimental and clinical experience. Brain Circ. 2017;3(4):186-98.

15. Soleimanpour H, Rahmani F, Safari S, Golzari SE. Hypo-thermia after cardiac arrest as a novel approach to increase survival in cardiopulmonary cerebral resuscitation: a review. Iran Red Crescent Med J. 2014;16(7):e17497.

16. Soleimanpour H, Rahmani F, Golzari SE, Safari S. Main complications of mild induced hypothermia after cardiac ar-rest: a review article. J Cardiovasc Thorac Res. 2014;6(1):1-8.

17. Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384(24):2283-94.

18. Soleimanpour M, Rahmani F, Naghizadeh Golzari M, Ala A, Morteza Bagi HR, Mehdizadeh Esfanjani R, et al. Compari-son of electronic learning versus lecture-based learning in improving emergency medicine residents' knowledge about mild induced hypothermia after cardiac arrest. Anesth Pain Med. 2017;7(4):e57821.

19. Andrews PJ, Sinclair HL, Rodriguez A, Harris BA, Battison CG, Rhodes JK, et al. Hypothermia for intracranial hyperten-sion after traumatic brain injury. N Engl J Med. 2015;373(25):2403-12.

20. Cooper DJ, Nichol AD, Bailey M, Bernard S, Cameron PA, Pili-Floury S, et al. Effect of early sustained prophylactic hy-pothermia on neurologic outcomes among patients with se-vere traumatic brain injury: the POLAR randomized clinical trial. JAMA. 2018;320(21):2211-20.

21. Ashayeri H, Balafar M, Ebrahimi A, Soleimanpour H, Hajipoor-Kashgsaray N, Shahsavarinia K, et al. Therapeutic hypothermia in patients with traumatic brain injury: an um-brella review. BMC Neurol. 2025;25(1):440.

22. Velle F, Lewén A, Howells T, Enblad P, Nilsson P. Intra-cranial pressure–based barbiturate coma treatment in chil-dren with refractory intracranial hypertension due to trau-matic brain injury. J Neurosurg Pediatr. 2019;25(4):375-83.

23. Velle F, Lewén A, Howells T, Nilsson P, Enblad P. Tem-poral effects of barbiturate coma on intracranial pressure and compensatory reserve in children with traumatic brain injury. Acta Neurochir (Wien). 2021;163(2):489-98.

24. MRC CRASH Trial Collaborators. Predicting outcome after traumatic brain injury: practical prognostic models based on large cohort of international patients. BMJ. 2008;336(7641):425-9.

25. Steyerberg EW, Mushkudiani N, Perel P, Butcher I, Lu J, McHugh GS, et al. Predicting outcome after traumatic brain injury: development and international validation of prognos-tic scores based on admission characteristics. PLoS Med. 2008;5(8):e165.

26. Roozenbeek B, Lingsma HF, Lecky FE, Lu J, Weir J, Butch-er I, et al. Prediction of outcome after moderate and severe traumatic brain injury: external validation of the Interna-tional Mission on Prognosis and Analysis of Clinical Trials (IMPACT) and Corticoid Randomisation After Significant Head injury (CRASH) prognostic models. Crit Care Med. 2012;40(5):1609-17.

27. Khalili H, Rismani M, Nematollahi MA, Masoudi MS, Asadollahi A, Taheri R, et al. Prognosis prediction in traumat-ic brain injury patients using machine learning algorithms. Sci Rep. 2023;13(1):960.

28. Arefan D, Pease M, Eagle SR, Okonkwo DO, Wu S. Com-parison of machine learning models to predict long-term out-comes after severe traumatic brain injury. Neurosurg Focus. 2023;54(6):E14.

29. Raj R, Luostarinen T, Pursiainen E, Posti JP, Takala RS, Bendel S, et al. Machine learning-based dynamic mortality prediction after traumatic brain injury. Sci Rep. 2019;9(1):17672.

30. Senders JT, Staples PC, Karhade AV, Zaki MM, Gormley WB, Broekman MLD, et al. Machine learning and neurosurgi-cal outcome prediction: a systematic review. World Neuro-surg. 2018;109:476-86. e1.

31. Collins GS, Moons KGM, Dhiman P, Riley RD, Beam AL, Van Calster B, et al. TRIPOD+AI statement: updated guidance for reporting clinical prediction models that use regression or machine learning methods. BMJ. 2024;385:e078378.

32. Mahmoodpoor A, Shokouhi G, Hamishehkar H, So-leimanpour H, Sanaie S, Porhomayon J, et al. A pilot trial of L-carnitine in patients with traumatic brain injury: effects on biomarkers of injury. J Crit Care. 2018;45:128-32.

33. Rangel-Castilla L, Gopinath S, Robertson CS. Management of intracranial hypertension. Neurol Clin. 2008;26(2):521-41.

34. Heathcote A, Hooper K, Cooper M, Lee S, Tang F, Batta V, et al. The CoolCot trial: active methods of therapeutic hypo-thermia for newborns with hypoxic ischaemic encephalopa-thy (HIE) during neonatal transport: a study protocol for a randomised controlled trial comparing battery-enabled ser-vo-controlled cooling blankets and ice-gel pack methods. Tri-als. 2025;26(1):375.

35. Guo R, Yang Q, Zhou X, Li S, Liu Y. Characteristic of clini-cal trials related to traumatic brain injury registered on Clini-calTrials. Front Med (Lausanne). 2024;11:1435762.

36. Bassin SL, Bleck TP. Barbiturates for the treatment of in-tracranial hypertension after traumatic brain injury. Crit Care. 2008;12(5):185.

37. Battaglini D, Anania P, Rocco PRM, Brunetti I, Prior A, Zona G, et al. Escalate and de-escalate therapies for intracra-nial pressure control in traumatic brain injury. Front Neurol. 2020;11:564751.

38. Pérez-Bárcena J, Llompart-Pou JA, Homar J, Abadal JM, Raurich JM, Frontera G, et al. Pentobarbital versus thiopental in the treatment of refractory intracranial hypertension in patients with traumatic brain injury: a randomized controlled trial. Crit Care. 2008;12(4): R112.

39. Heard KJ, Peberdy MA, Sayre MR, Sanders A, Geocadin RG, Dixon SR, et al. A randomized controlled trial comparing the Arctic Sun to standard cooling for induction of hypo-thermia after cardiac arrest. Resuscitation. 2010;81(1):9-14.

40. Jain A, Gray M, Slisz S, Haymore J, Badjatia N, Kulstad E. Shivering treatments for targeted temperature management: a review. J Neurosci Nurs. 2018;50(2):63-7.

41. Badjatia N, Strongilis E, Gordon E, Prescutti M, Fernandez L, Fernandez A, et al. Metabolic impact of shivering during therapeutic temperature modulation: the Bedside Shivering Assessment Scale. Stroke. 2008;39(12):3242-7.

42. Martin GP, Riley RD, Ensor J, Grant SW. Statistical primer: sample size considerations for developing and validating clin-ical prediction models. Eur J Cardiothorac Surg. 2025;67(5): ezaf142.

43. Pavlou M, Ambler G, Seaman S, De Iorio M, Omar RZ. Re-view and evaluation of penalised regression methods for risk prediction in low-dimensional data with few events. Stat Med. 2016;35(7):1159-77.

44. Fiscella K, Sanders M, Holder T, Carroll JK, Luque A, Cas-sells A, et al. The role of data and safety monitoring boards in implementation trials: when are they justified? J Clin Transl Sci. 2020;4(3):229-32.

45. McCoy CE. Understanding the intention-to-treat principle in randomized controlled trials. West J Emerg Med. 2017;18(6):1075-8.

46. Smith VA, Coffman CJ, Hudgens MG. Interpreting the re-sults of intention-to-treat, per-protocol, and as-treated anal-yses of clinical trials. JAMA. 2021;326(5):433-4.

47. Roozenbeek B, Lingsma HF, Perel P, Edwards P, Roberts I, Murray GD, et al. The added value of ordinal analysis in clinical trials: an example in traumatic brain injury. Crit Care. 2011;15(3): R127.

48. Pohl M, Baumann L, Behnisch R, Kirchner M, Krisam J, Sander A. Estimands-a basic element for clinical trials. Dtsch Arztebl Int. 2021;118(51-52):883-8.

49. Suhas S, Manjunatha N, Kumar CN, Benegal V, Rao GN, Varghese M, et al. Firth's penalized logistic regression: a su-perior approach for analysis of data from India's National Mental Health Survey, 2016. Indian J Psychiatry. 2023;65(12):1208-13.

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