A meta-analysis of treating acute traumatic brain injury with calcium channel blockers

The purpose of this systematic review was to evaluate and meta-analyse the current evidence for the use of calcium channel blockers (CCBs) in the treatment of acute traumatic brain injury (TBI) and traumatic subarachnoid haemorrhage (tSAH). A systematic search of clinical trials.gov, Cochrane library databases, EMBASE, MEDLINE, Web of science search and WHO trial registry, plus hand-searching of grey literature, was undertaken in March 2013. Two reviewers independently extracted the data using a pre-defined data extraction form. RevMan 5 software was used to synthesise data and calculate the risk ratio (RR) based on event rates as well as the 95% confidence interval (CI). Finally, nine RCTs with a total of 2182 patients were included. Meta-analysis showed that there was no difference between CCBs and control groups for rates of mortality (n= 1337, 5 RCTs, RR 0.93 CI 0.77-1.12). In a subgroup tSAH analysis, the difference was not significant (n= 389, 2 RCTs, RR 0.73 CI 0.53-1.02). There were slightly fewer unfavourable outcomes in the treatment group, but the difference was not statistically significant (n= 2101, 8 RCTs, RR 0.90 CI 0.76-1.08). In the subgroup tSAH analysis, again, the difference did not reach statistical significance (n= 1074, 5 RCTs, RR 0.95 CI 0.73-1.24). It seems that larger, well-designed RCTs are necessary in order to ascertain any clinical benefit CCBs may or may not have for the treatment of acute TBI.