RESCUEicp
RESCUEicp Trial Summary
Objective
The RESCUEicp (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure) trial aimed to assess the effectiveness of decompressive craniectomy in patients with traumatic brain injury and refractory intracranial hypertension.
Methods
- Design: Multicenter, randomized controlled trial.
- Participants: 408 patients aged 10 to 65 years with traumatic brain injury and refractory intracranial hypertension (>25 mm Hg).
- Interventions: Patients were randomized to undergo decompressive craniectomy or receive ongoing medical care.
- Outcome Measures: The primary outcome was the score on the Extended Glasgow Outcome Scale (GOS-E) at 6 months. Secondary outcomes included mortality rates at 6 and 12 months, functional outcomes, and adverse events.
Results
- Primary Outcome: The GOS-E distribution at 6 months showed that decompressive craniectomy resulted in lower mortality (26.9% vs. 48.9%) but higher rates of vegetative state (8.5% vs. 2.1%), lower severe disability (21.9% vs. 14.4%), and upper severe disability (15.4% vs. 8.0%) compared to medical care.
- Secondary Outcomes: At 12 months, the mortality rate was 30.4% in the surgical group and 52.0% in the medical group. The rates of vegetative state, lower severe disability, and upper severe disability remained higher in the surgical group.
- Adverse Events: The surgical group had a higher rate of adverse events (16.3% vs. 9.2%).
Conclusion
Decompressive craniectomy in patients with traumatic brain injury and refractory intracranial hypertension reduced mortality but increased the risk of severe disability and vegetative state compared to medical care alone. These findings highlight the need for careful consideration of the benefits and risks of decompressive craniectomy in managing traumatic brain injury.
Reference
Hutchinson PJ, Kolias AG, Timofeev IS, et al. Decompressive Craniectomy for Traumatic Intracranial Hypertension. N Engl J Med 2016; 375:1119-30. File:RESCUEicp.pdf