Alcohol Might Lower Death Rates in Brain Injury Patients
FRIDAY Sept. 25, 2009 -- People who suffer serious head injuries are more likely to survive if they have alcohol in their bloodstream, a new study suggests.
Data on more than 38,000 people with such injuries showed that 9.7 percent of those with no trace of alcohol in the bloodstream died in the hospital, compared to a 7.7 percent death rate for those whose tests showed the presence of alcohol, according to a report in the September issue of the Archives of Surgery.
While the injured people whose blood contained alcohol were more likely to have complications (12.9 percent versus 9.8 percent), they spent less time on a ventilator or in the intensive care unit, said researchers at Cedars-Sinai Medical Center in Los Angeles.
The information came from analysis of the 53 percent of 72,294 cases listed in the National Trauma Data Bank in which alcohol testing was done. Traces of alcohol were found in 37.9 percent of those tested.
Smaller human studies have shown the same effect, as have animal studies, the report said. The animal studies indicated several possible mechanisms for alcohol's protective effect, such as diminished activity of catecholamines, the "fight-or-flight" hormones that include adrenaline, the researchers wrote.
"Our group has been working on blunting these catecholamine responses," said study author Dr. Ali Salim, an associate professor of surgery at Cedars-Sinai. "We came across animal studies showing that alcohol can do that in brain injury, so we looked at our largest database to see if we could find a correlation."
The study "raises the intriguing possibility that administering ethanol [alcohol] to patients with brain injuries may improve outcome," the report said.
But it's a possibility that requires intensive study before being put into medical use, said Dr. Homer C.N. Tien, an assistant professor of surgery at the University of Toronto, who led a study that found similar results three years ago.
"It just raises a possibility," Tien said of the new study. "The message is that we should look at this more closely."
What would be needed would be more studies in both animals and humans, he said. "Then we might propose a trial to give alcohol to people who have brain injury."
The higher incidence of complications seen in people who have alcohol in their blood when they suffer brain injuries is understandable, Tien said. "People who drink and drive tend to have alcohol abuse or dependence problems, so they are more likely to have health issues," he said.
And alcohol has to be handled carefully in medicine and real life, Tien said. "The report was very careful to say that alcohol has a huge potential to destroy life," he said. "From a public health point of view, it is not something we should mess with. But ethanol may have a pharmacological role if administered in discrete amounts in certain circumstances."
Dr. M. Sean Grady, chairman of the department of neurosurgery at the University of Pennsylvania, was even more cautious.
"I have a lot of caveats about the information they provide," he said. "Only half the people in the database had their blood alcohol measured, so we have to worry about their conclusions."
While Grady said "the novel use of a large database is a major contribution, I'm not confident that their observation is true or not."
Like Tien, Grady said more research on the issue is needed. "Instead of using an administrative database, we could do a number of clinical trials for traumatic brain injury collecting ethanol data as part of the studies," he said. "Those studies would have more detail and could give a better sense of whether ethanol plays a positive or negative role."
"Mechanism-wise, we need to figure out more about why this happens," Salim said. "We need to know about why it happens and how much alcohol we might need. Higher levels seem to worsen outcome. Also, we have to look at timing. A lot needs to be worked out."
Funding for studies of alcohol in brain injury would not be easy to get "because you're talking about an agent that contributes to brain injury," Salim said. "The key is to look at mechanism, and try to find alternatives for that mechanism."
Advice on avoiding brain injuries is given by the U.S. Centers for Disease Control and Prevention.
Posted: September 2009
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