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Hypothermia in TBI — FRCA Final MCQ

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HardIntensive Care MedicineHypothermia in TBIFRCA Final

In the Eurotherm3235 trial, adults with traumatic brain injury and an intracranial pressure above 20 mmHg despite first-line treatment were randomised to standard care or titrated therapeutic hypothermia at 32–35°C. Which statement best describes the trial findings?

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Correct answer: E — Reduced intracranial pressure but worse 6-month functional outcome and mortality

Explanation lettering: E = shown as A · A = shown as B · B = shown as E

B is correct. Eurotherm3235 studied therapeutic, not prophylactic, hypothermia in adults whose intracranial pressure remained above 20 mmHg despite first-line measures. Cooling to 32–35°C successfully reduced intracranial pressure, but the trial was stopped following Data and Safety Monitoring Committee concerns. At 6 months, mortality was higher and functional recovery on the Glasgow Outcome Scale–Extended was poorer with hypothermia; the adjusted common odds ratio was 1.54 and favoured standard care. Therefore, A and C incorrectly claim clinical benefit, while D overlooks the adverse outcome signal despite ICP reduction. No beneficial interaction was demonstrated in patients younger than 45 years, excluding E. The result does not mean temperature is ignored: contemporary practice emphasises continuous monitoring, fever treatment and controlled normothermia, with deeper hypothermia not used routinely on the basis of this trial.

Reference: Andrews PJD et al. Therapeutic hypothermia to reduce intracranial pressure after traumatic brain injury: the Eurotherm3235 RCT. Health Technology Assessment. 2018;22(45):1–134. https://pubmed.ncbi.nlm.nih.gov/30168413/