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Thu Jan 4 19:00:14 GMT 2007

This shouldn't be an indictment of the premise, only
of (allegedly) the actions of one group.

The Cochrane link sent by Rangraj was both
enlightening and saddening all at once.

Ben Reynolds, PA-C
Pittsburgh, PA

--- Guy Jackson <r.g.m.jackson at qmul.ac.uk> wrote:

> Tim,
> 
> Sad indeed.
> 
> The question is: should this change management? My
> guess is not for many of
> us, as we don't use this much acutely anyway. The
> trouble is the lack of
> data (now even worse) for therapies that come from
> the age when new ones
> could be introduced without proper RCTs. Perhaps the
> best outcome from this
> sorry episode might be called CRASH 3?
> 
> Guy Jackson
> London, UK
> 
> 
> ----- Original Message ----- 
> From: "Coats Tim - Professor of Emergency Medicine"
> <Tim.Coats at uhl-tr.nhs.uk>
> To: <trauma-list at trauma.org>
> Sent: Thursday, January 04, 2007 11:35 AM
> Subject: High Dose Mannitol
> 
> 
> Dear all,
> 
> Prof Ian Roberts, who chairs the Cochrane Injuries
> Group, has asked me
> to pass on the information below, which has led to
> the withdrawal of the
> Cochrane review on high dose mannitol. Details are
> available on the
> CRASH2 website.
> My interpretation is that this is a sad story and
> that we will probably
> never know the truth. However it does seem that the
> data in the three
> published papers cannot be verified, greatly
> reducing the body of
> evidence for high dose mannitol therapy.
> 
> Tim. Coats.
> Professor of Emergency Medicine.
> Leicester University
> 
> Dear Tim
> The Cochrane Injuries Group conducted an
> investigation into some head
> injury trials by Cruz et al - the details should be
> of interest to the
> trauma community.
> We have put the key correspondence on the trial
> website to make it
> available to our collaborators but I wondered if you
> could let the folk
> at trauma.org know about it as well.
> Between 2001 and 2004, three reports were published
> by Dr Julio Cruz and
> colleagues presenting the results of three clinical
> trials comparing
> high dose and conventional dose mannitol in the
> treatment of head
> injury. They appeared to show that high dose
> mannitol was dramatically
> effective in reducing death and disability after
> head injury.
> Cruz C, Minoja G, Okuchi K. Improving clinical
> outcomes from acute
> subdural hematomas with emergency preoperative
> administration of high
> doses of mannitol: a randomized trial. Neurosurgery
> 2001;49(4):864-71.
> Cruz C, Minoja G, Okuchi K. Major clinical and
> physiological benefits of
> early high doses of mannitol for intraparenchymal
> temporal lobe
> hemorrhages with abnormal pupilary widening.
> Neurosurgery
> 2002;51(3):628-38.
> Cruz J, Minoja G, Okuchi K, Facco E. Successful use
> of the new high-dose
> mannitol treatment in patients with Glasgow Coma
> Scores of 3 and
> bilateral abnormal pupillary widening: a randomized
> trial. Journal of
> Neurosurgery 2004;100(3):376-83.
> The trials were included in a systematic review of
> the effectiveness of
> mannitol in head injury and published in the
> Cochrane Library in July
> 2005. The review concluded that "high dose mannitol
> appears to be
> preferable to conventional dose mannitol in the
> acute management of
> comatose patients with severe head injury."
> The Cochrane Injuries Group later discovered that
> there were concerns
> about these trials and an investigation was made the
> results of which
> are available on the CRASH-2 website
> (www.crash2.lshtm.ac.uk
>
</exchweb/bin/redir.asp?URL=http://www.crash2.lshtm.ac.uk>
> ). We know
> that mannitol is widely used in the management of
> patients with head
> trauma and felt that you should be made aware of the
> Injuries Group
> investigation as soon as possible. Please pass this
> message on to your
> colleagues in trauma care.
> Ian
> 
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