***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Hypothermia therapy improves survival and the neurologic outcome in animal models of traumatic brain injury . However , the effect of hypothermia therapy on the neurologic outcome and mortality among children who have severe traumatic brain injury is unknown . METHODS In a multicenter , international trial , we r and omly assigned children with severe traumatic brain injury to either hypothermia therapy ( 32.5 degrees C for 24 hours ) initiated within 8 hours after injury or to normothermia ( 37.0 degrees C ) . The primary outcome was the proportion of children who had an unfavorable outcome ( i.e. , severe disability , persistent vegetative state , or death ) , as assessed on the basis of the Pediatric Cerebral Performance Category score at 6 months . RESULTS A total of 225 children were r and omly assigned to the hypothermia group or the normothermia group ; the mean temperatures achieved in the two groups were 33.1+/-1.2 degrees C and 36.9+/-0.5 degrees C , respectively . At 6 months , 31 % of the patients in the hypothermia group , as compared with 22 % of the patients in the normothermia group , had an unfavorable outcome ( relative risk , 1.41 ; 95 % confidence interval [ CI ] , 0.89 to 2.22 ; P=0.14 ) . There were 23 deaths ( 21 % ) in the hypothermia group and 14 deaths ( 12 % ) in the normothermia group ( relative risk , 1.40 ; 95 % CI , 0.90 to 2.27 ; P=0.06 ) . There was more hypotension ( P=0.047 ) and more vasoactive agents were administered ( P<0.001 ) in the hypothermia group during the rewarming period than in the normothermia group . Lengths of stay in the intensive care unit and in the hospital and other adverse events were similar in the two groups . CONCLUSIONS In children with severe traumatic brain injury , hypothermia therapy that is initiated within 8 hours after injury and continued for 24 hours does not improve the neurologic outcome and may increase mortality . ( Current Controlled Trials number , IS RCT N77393684 [ controlled-trials.com ] . ) INTRODUCTION Traumatic brain injury ( TBI ) is a leading cause of death and disability worldwide . Prophylactic hypothermia is effective in laboratory models , but clinical studies to date have been inconclusive , partly because of method ological limitations . Our Prophylactic Hypothermia Trial to Lessen Traumatic Brain Injury ( POLAR ) r and omised controlled trial is currently underway comparing early , sustained hypothermia versus st and ard care in patients with severe TBI . We describe our study protocol and the challenges in conducting prophylactic hypothermia research in TBI . DESIGN We aim to r and omise 500 patients to either prophylactic 33 ° C hypothermia initiated within 3 hours of injury and continued for at least 72 hours , or st and ard normothermic management .  Patients will be enrolled by paramedic services in the prehospital setting , or by emergency department staff at participating sites in Australia , New Zeal and and Europe . The primary outcome will be the eight-level extended Glasgow outcome scale ( GOSE ) , dichotomised to favourable and unfavourable outcomes at 6 months after injury . Secondary outcomes will include mortality at hospital discharge and at 6 months , ordinal analyses of 6-month GOSE outcomes , quality of life with health economic evaluations and the differential proportion of adverse events . We will predefine subgroup and interaction analyses . DISCUSSION After a run-in phase , recruitment for our main study began in December 2010 . When the study is completed , we aim to provide evidence on the efficacy of prophylactic hypothermia in TBI to guide clinicians in their management of this devastating condition BACKGROUND The inconsistent effect of hypothermia treatment on severe brain injury in previous trials might be because hypothermia was induced too late after injury . We aim ed to assess whether very early induction of hypothermia improves outcome in patients with severe brain injury . METHODS The National Acute Brain Injury Study : Hypothermia II ( NABIS : H II ) was a r and omised , multicentre clinical trial of patients with severe brain injury who were enrolled within 2·5 h of injury at six sites in the USA and Canada . Patients with non-penetrating brain injury who were 16 - 45 years old and were not responsive to instructions were r and omly assigned ( 1:1 ) by a r and om number generator to hypothermia or normothermia . Patients r and omly assigned to hypothermia were cooled to 35 ° C until their trauma assessment was completed . Patients who had none of a second set of exclusion criteria were either cooled to 33 ° C for 48 h and then gradually rewarmed or treated at normothermia , depending upon their initial treatment assignment . Investigators who assessed the outcome measures were masked to treatment allocation . The primary outcome was the Glasgow outcome scale score at 6 months . Analysis was by modified intention to treat . This trial is registered with Clinical Trials.gov , NCT00178711 . FINDINGS Enrolment occurred from December , 2005 , to June , 2009 , when the trial was terminated for futility . Follow-up was from June , 2006 , to December , 2009 . 232 patients were initially r and omised a mean of 1·6 h ( SD 0·5 ) after injury : 119 to hypothermia and 113 to normothermia . 97 patients ( 52 in the hypothermia group and 45 in the normothermia group ) did not meet any of the second set of exclusion criteria . The mean time to 35 ° C for the 52 patients in the hypothermia group was 2·6 h ( SD 1·2 ) and to 33 ° C was 4·4 h ( 1·5 ) . Outcome was poor ( severe disability , vegetative state , or death ) in 31 of 52 patients in the hypothermia group and 25 of 56 in the normothermia group ( relative risk [ RR ] 1·08 , 95 % CI 0·76 - 1·53 ; p=0·67 ) . 12 patients in the hypothermia group died compared with eight in the normothermia group ( RR 1·30 , 95 % CI 0·58 - 2·52 ; p=0·52 ) . INTERPRETATION This trial did not confirm the utility of hypothermia as a primary neuroprotective strategy in patients with severe traumatic brain injury Objective : Severe head trauma and /or severe hypothermia ( ≤32 ° C ) can cause cardiac arrhythmias . Effect of moderate hypothermia ( 32 - 33 ° C ) on cardiac arrhythmias in children after severe traumatic brain injury is not well characterized . The objective is to determine the effect of moderate and short-term ( 24 hrs ) hypothermia therapy on the incidence and severity of cardiac arrhythmias in children with severe traumatic brain injury compared with normothermic control subject using a 24-hr Holter recording . Design : Prospect i ve ancillary study of a multicenter r and omized , controlled clinical trial . Setting : A Canadian university-affiliated pediatric intensive care unit in a level III trauma center . Patients : Patients < 18 yrs with severe traumatic brain injury . Interventions : Holter recording during moderate hypothermia ( HYPO group ; esophageal temperature 32 - 33 ° C ) or normothermia ( NORMO group ; 36.5 - 37.5 ° C ) induced for 24 hrs started within 8 hrs after a severe traumatic brain injury . Measurements and Main Results : Sixteen patients who had a median age of 12.7 yrs ( range , 7.2 - 17.0 yrs ) were enrolled . The time from the injury to the start of the cooling process was 7.3 hrs ( range , 6.6 - 7.8 hrs ) . The temperature when Holter recording began was 32.9 ° C ( range , 31.6 - 34.4 ° C ) in the HYPO group . Overall , 44 % of all patients ( seven of 16 patients ) had arrhythmias ( two of nine in the NORMO group and five of seven in the HYPO group , p = .13 ) . The most frequent arrhythmias were isolated premature atrial contractions . Hypothermic patients had lower heart rates than normothermic patients ( p = .01 ) , but none had a severe bradycardia . In the NORMO group , one patient had accelerated junctional rhythm associated with hypotension . In the HYPO group , one patient had nonsustained monomorphic ventricular tachycardia . Conclusions : Arrhythmias are frequent in severe pediatric traumatic brain injury . Further studies are needed to characterize the epidemiology and clinical impact of arrhythmias associated with severe pediatric head trauma and moderate hypothermia Background : Induced hypothermia for treatment of traumatic brain injury is controversial . Since many pathways involved in the pathophysiology of secondary brain injury are temperature dependent , regional brain hypothermia is thought capable to mitigate those processes . The objectives of this study are to assess the therapeutic effects and complications of regional brain cooling in severe head injury with Glasgow coma scale ( GCS ) 6 - 7 . Material s and Methods : A prospect i ve r and omized controlled pilot study involving patients with severe traumatic brain injury with GCS 6 and 7 who required decompressive craniectomy . Patients were r and omized into two groups : Cooling and no cooling . For the cooling group , analysis was made by dividing the group into mild and deep cooling . Brain was cooled by irrigating the brain continuously with cold Hartmann solution for 24 - 48 h. Main outcome assessment s were a dichotomized Glasgow outcome score ( GOS ) at 6 months posttrauma . Results : A total of 32 patients were recruited . The cooling-treated patients did better than no cooling . There were 63.2 % of patients in cooling group attained good GOS at 6 months compared to only 15.4 % in noncooling group ( P = 0.007 ) . Interestingly , the analysis at 6 months post-trauma disclosed mild-cooling-treated patients did better than no cooling ( 70 % vs. 15.4 % attained good GOS , P = 0.013 ) and apparently , the deep-cooling-treated patients failed to be better than either no cooling ( P = 0.074 ) or mild cooling group ( P = 0.650 ) . Conclusion : Data from this pilot study imply direct regional brain hypothermia appears safe , feasible and maybe beneficial in treating severely head-injured patients Purpose : To evaluate the efficacy and safety of mild induced hypothermia for intracranial hypertension in patients with traumatic brain injury after decompressive craniectomy . Methods : A total of 60 adults with intracranial pressure ( ICP ) of more than 20 mm Hg after decompressive craniectomy were r and omly assigned to st and ard care ( control group ) or hypothermia ( 32 ° C‐35 ° C ) plus st and ard care . Then , ICP , cerebral perfusion pressure , Glasgow Outcome Scale score , and complications were assessed . Results : There was a significant difference in ICP and cerebral perfusion pressure between the 2 groups . Favorable outcomes occurred in 12 ( 40.0 % ) and 7 ( 36.5 % ) patients in the hypothermia and control groups , respectively ( P = .267 ) . Kaplan‐Meier curves revealed a marked difference in survival between the hypothermia and control groups ( P = .032 ) . There were significant differences in pulmonary infection and electrolyte disorders between the hypothermia and control groups ( P = .038 and .033 , respectively ) . Conclusion : Mild induced hypothermia can reduce intracranial hypertension after decompressive craniectomy , decreasing patient mortality . Hypothermia should be considered one of the main treatments for intracranial hypertension after decompressive craniectomy in patients with traumatic brain injury . HighlightsThis is a r and omized controlled trial research .Mild induced hypothermia therapeutics can reduce the intracranial hypertension after the decompressive craniectomy and can reduce the mortality of the patients Rationale Intracerebral hemorrhage causes 15 % of strokes annually in the United States , and there is currently no effective therapy . Aims and hypothesis This is a clinical trial design ed to study the safety , feasibility , and efficacy of a protocol of targeted temperature management to moderate hypothermia in intracerebral hemorrhage patients . Methods The targeted temperature management after intracerebral hemorrhage trial is a prospect i ve , single-center , interventional , r and omized , parallel , two-arm ( 1:1 ) phase-II clinical trial with blinded end-point ascertainment . Intracerebral hemorrhage patients will be r and omized within 18 h of symptom onset to either 72 h of targeted temperature management to moderate hypothermia  ( 32–34 ° C ) followed by a controlled rewarming at of 0·05–0·1 ° C per hour or 72 h of targeted temperature management to normothermia ( 36–37 ° C ) using endovascular or surface cooling . Outcomes The primary outcome is the development of serious adverse events possibly and probably related to treatment . Secondary outcomes include in-hospital neurological deterioration between day 0–7 , in-hospital mortality , functional outcome measured by the modified Rankin scale at dis 
    Output:
    
Despite a large number studies , there remains no high- quality evidence that hypothermia is beneficial in the treatment of people with TBI .
Further research , which is method ologically robust , is required in this field to establish the effect of hypothermia for people with TBI