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The RESCUEicp decompressive craniectomy trial

Introduction

The RESCUEicp study (Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of Intracranial Pressure) aims to provide Class 1 randomised evidence as to whether decompressive craniectomy is effective for the management of patients with raised and refractory intracranial pressure (ICP) following traumatic brain injury.

Methods

An international multicentre randomised trial comparing decompressive craniectomy with medical management. Patients (n = 50 for the pilot phase, n = 600 for the main study) with traumatic brain injury and raised ICP (>25 mmHg) refractory to initial treatment measures are eligible for the study. Patients are randomised to one of two arms: continuation of optimal medical management (including barbiturates) versus surgery (decompressive craniectomy). The inclusion criteria are: traumatic brain injury, age 10 to 65 years, abnormal CT scan and the exclusion criteria: bilateral fixed and dilated pupils, bleeding diathesis, devastating injury not expected to survive 24 hours. Outcome is assessed using the extended Glasgow Outcome Score and the SF-36 quality of life questionnaire at 6 months, 1 year and 2 years. See Figure 1.

Figure 1
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abstract

Results

Over 170 patients have been recruited to date. At present we have achieved 97% data collection and 94% follow up. The study is ongoing.

Conclusion

Randomising patients with traumatic brain injury to decompressive craniectomy versus optimal medical management is feasible. Whether the operation is effective and safe remains to be seen. We would welcome more centers' participation.

References

  1. 1.

    Timofeev I, Hutchinson PJ: Outcome after surgical decompression of severe traumatic brain injury. Injury 2006, 37: 1125-1132. 10.1016/j.injury.2006.07.031

  2. 2.

    Winter CD, et al.: The role of decompressive craniectomy in the management of traumatic brain injury: a critical review. J Clin Neurosci 2005, 12: 619-623. 10.1016/j.jocn.2005.02.002

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Hutchinson, P., Timofeev, I., Grainger, S. et al. The RESCUEicp decompressive craniectomy trial. Crit Care 13, P85 (2009). https://doi.org/10.1186/cc7249

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Keywords

  • Traumatic Brain Injury
  • Medical Management
  • Intracranial Pressure
  • Barbiturate
  • Main Study