Risk-benefit Analysis of Barbiturate Coma Therapy in Patients Who Received Decompressive Craniectomy for Malignant Cerebral Infarction

Objective In our study, we analyzed the risks and benefits of barbiturate coma therapy (BCT) in patients who received decompressive craniectomy for malignant cerebral infarction (MCI) in the past 11 years. Additionally, we evaluated the factors affecting the functional outcomes in these patients. Methods A retrospective analysis was performed for all patients who underwent decompressive craniectomy for MCI between August 2005 and May 2016. Based on the routine use of BCT, patients were divided into two groups: BCT group with immediate use of BCT after decompressive craniectomy and control group without use of BCT. Results There was no significant difference in one-month mortality between the BCT and non-BCT groups (p=0.477). One-year survival rates were 65.7% and 58.4%, and 2-year survival rates were 56.3% and 54.2% in the BCT and control groups, respectively. Glasgow Outcome Scale scores of the two groups showed a significant difference in favour of control group at 1 month after the surgery (p=0.034), but not at 6 months after surgery (p=0.494). Adverse events and complications occurred more frequently in the BCT group than in the control group. Conclusion Based on our results, we concluded that BCT for patients with MCI does not always result in a positive outcome. We oppose the use of BCT as a routine conventional treatment. However, it may be considered as an adjunct measure when maximum conventional treatment fails. Key words: Barbiturates; Decompressive craniectomy; Cerebral infarction; Glasgow outcome scale