![]() The use of barbiturates were prohibited in stage 1 and stage 2 medical therapies, but permitted in the group randomised to non-surgical management. Surgery (either unilateral frontotemporoparietal hemi-craniectomy or bifrontal craniectomy, depending on the pattern of injury and at the discretion of the surgical team) was considered a ‘last tier’ intervention and to be eligible for randomisation patients needed to have ICP >25mmHg for >1 hour (but <12 hours) despite stage 1 and stage 2 medical therapies. ![]() ![]() Patients with fixed dilated pupils, bleeding diathesis or an injury which was deemed unsurvivable were excluded. The study recruited older children (age ≥10) and adults (age ≤65) with severe TBI from centres that could offer around-the-clock neurosurgical services. Like the DECRA trial patients with TBI and refractory intracranial hypertension were randomised to receive either surgery and optimal medical therapy, or optimal medical therapy alone. The Randomised Evaluation of Surgery with Craniectomy for Uncontrollable Elevation of intracranial pressure (RESCUEicp) trial is a prospective multi-centre randomised controlled trial, recruiting from 24 countries (71% of patients recruited from the United Kingdom). 51%, p=0.02) whilst mortality was similar (19% vs. In the DECRA study significantly more patients in the craniectomy group had an unfavourable neurological outcome at 6 months (70% vs. The previously published DECRA study recruited 155 patients with TBI and ICP >20mmHg for >15 minutes despite optimal medical therapy and randomised them to receive decompressive craniectomy or standard care alone. Intracranial hypertension following traumatic brain injury (TBI) has been associated with increased mortality and recently published international guidelines recommend treating intracranial pressure (ICP) >22mmHg to minimise the risk of secondary brain injury.
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