In the 1950s and 1960s, clinicians believed that the causes of death in TBI were brain swelling and increased intracranial pressure, and therefore believed that the prognosis of TBI could be improved if high intracranial pressure was well controlled. In a pilot study, Lund (3) found that hypothermia was more effective than hyperventilation in reducing intracranial pressure. However, at that time, clinicians were not aware of the details of what the optimal treatment temperature was, how long the appropriate cooling time should be, how to rewarm and its safety, and complications, which resulted in serious and even fatal complications during hypothermia treatment. Experimental studies in the 1990s found that short-term cooling above 30°C improved treatment outcomes, an important finding because many serious complications occurred during prolonged cooling below 30°C. Several small clinical trials based on the above trials using sub-cold temperatures (32-33°C) for severe TBI found that the incidence of serious complications was reduced (4). However, clinical studies published in recent years on hypothermia for severe TBI are contradictory, with prospective clinical studies reported in a single unit finding hypothermia effective (4,5,8,) but two large group multicenter randomized controlled prospective clinical studies finding hypothermia ineffective for severe TBI. The National AcuteBrainInjury (NABIS:H) study was started from October 1994 to May 1998, with 500 cases scheduled to be completed, but the safety committee stopped the trial in May 1998 for safety reasons. The actual enrollment was 392 cases, 199 cases in the hypothermia treatment group and 193 cases in the normothermia treatment group as a control. The hypothermia group was cooled to 33°C at 8.4±3h on average and maintained at 47.2±3h. The mortality rate was 28% in the hypothermia group and 27% in the normothermia group (p=0.79), and at age >45 years, the prognosis of those with poor prognosis was 88% in the hypothermia group and 69% in the normothermia group, but the mortality rate was 38% in both groups. Severe hypotensive complications occurred in 10% of the hypothermia group and 3% of the normothermia group, and bradycardia occurred in 16% of the hypothermia group and 4% of the normothermia group, and the number of days in hospital was prolonged in the hypothermia group compared to the normothermia group. A small number of patients in the hypothermia group developed high cranial pressure less than the normothermia group, he concluded that the prognosis of heavy craniocerebral injury was not improved by hypothermia treatment at 33°C within 8 hours after heavy craniocerebral injury, the results of this clinical trial study published in the prestigious New England Journal of Medicine caused a sensation, the same year Shiozaki (7) in 11 hospitals to conduct a prospective randomized controlled study, collected 91 patients, cooling to The prognosis after 3 months was 46% in the hypothermia group and 59% in the normothermia group (P>0.99), and the same conclusion as Clifton was reached. There are many comments on the two different outcomes of hypothermia for heavy TBI, and the main reason for this analysis is that it is difficult to maintain complete consistency among centers regarding the physiology, metabolism and medications that affect prognosis during hypothermia treatment, and even in some large number of cases under the careful supervision of an intensive care unit the results are encouraging, and in the Clifton (9) multicenter clinical study there were indeed differences among centers, such as in In the Clifton(9) multicenter clinical study, there were indeed intercenter differences, for example, in the proportion of patients with mean arterial pressure below 70 mmHg in the hypothermia group (p<0.001) and dehydration (p<0.001) and in the proportion of cases with cerebral perfusion pressure below 50 mmHg (p<0.05), as well as in the application of anesthetics (p<0.001) and vasopressors (p<0.03) in each center, and in their multicenter study group, there were also intercenter differences. In two of the centers in the multicenter study group, the results of hypothermia treatment were better than in the other centers (6). All clinical studies reported that hypothermia was helpful in reducing the increase in intracranial pressure, and some studies found that the cooling period was effective, but the effect of reducing intracranial pressure rebounded after rewarming, so to prevent rebound, the rewarming process must be done slowly, not less than 12-24 h. However, controlling the increase in intracranial pressure does not necessarily mean that the prognosis is good, and several clinical studies reported that the reduction in intracranial pressure by hypothermia did not change the functional prognosis (4.6.11). In 2007, Qiu (10) reported that in 80 cases of heavy TBI treated with hypothermia after unilateral craniotomy and decompression compared to normothermic control group, 70% of the hypothermia group and 48% of the conventional group were found to be beneficial at one year post-injury (p<0.05). This analysis was based on the results of six complete clinical trials and concluded that there was no meaningful difference in mortality between the hypothermia and normothermia groups (11). Based on these clinical findings, hypothermia is not considered a standard treatment option for severe craniocerebral injury, but it can be applied as a means of controlling intracranial pressure increase (4). There are several international clinical studies on hypothermia for heavy TBI, such as Adelson (2005), who reported a phase I clinical study of 75 cases of children with heavy TBI treated with hypothermia and a phase III clinical study on its safety and feasibility (ClinicalTrial.gov.indentifier:NT00222742) Clifton on TBI clinical studies in adults under 45 years of age (NABIS: HIIR; clinicalTrails.gov.identifier:NCT00178711) Australia, New Zealand clinical studies in children (ClinicalTrials.gov.identifier:NCT00282269) and Japan clinical studies in adults (ClinicalTrials.gov.indentifier:NCT00134472)(4,13). We expect that the results of these studies will provide a scientific evaluation of the value of hypothermia for the treatment of severe TBI. In China, millions of patients with heavy TBI are hospitalized every year (12), and there have been nearly 1,000 clinical reports and basic research reports in China since the development of hypothermia for heavy TBI in the 1990s, but the methods vary from unit to unit, and the differences in observation indexes, cooling methods, and maintenance time are large, so it is difficult to form a strong and convincing scientific guidance program, so it is suggested that a national organization should be organized under the advocacy of the Society Therefore, it is suggested that the Society should organize a large group multicenter prospective randomized controlled clinical study of hypothermia for heavy TBI in China under the initiative of the Society, so as to summarize the experience in the treatment of heavy TBI in China and make our due contribution.