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[Therapeutic hypothermia after pediatric cardiac arrest]
1Unidad de Cuidados Intensivos Pediátricos, Hospital Guillermo Grant Benavente, Concepción, Chile. robustos64@yahoo.com.ar
Insights
Therapeutic hypothermia (TH) is feasible, effective, and safe for pediatric cardiac arrest. This pilot study showed improved neurological outcomes and survival rates in children treated with TH.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Cardiology
Context:
- Therapeutic hypothermia (TH) is established for adults with cardiac arrest and neonates with hypoxic ischemic encephalopathy.
- The application of TH in pediatric populations is less understood.
- This study investigates TH in children experiencing cardiac arrest.
Purpose:
- To evaluate the feasibility, efficacy, and safety of a therapeutic hypothermia program in pediatric cardiac arrest.
- To establish a protocol for TH implementation in a pediatric intensive care unit.
Summary:
- A pilot study involved six pediatric patients with cardiac arrest, utilizing external cooling to achieve mild hypothermia (34.0°C).
- The protocol included rapid sequence induction and a 48-hour cooling period, followed by a 14-hour rewarming phase.
- Hypokalemia was the primary adverse event; five patients survived to discharge with improved Glasgow Coma Scale scores, and three had favorable long-term neurological outcomes.
Impact:
- This pilot program demonstrated that mild therapeutic hypothermia is a feasible, effective, and safe intervention for pediatric cardiac arrest.
- The findings support the use of TH protocols in pediatric critical care settings.
- Successful implementation of TH can lead to improved neurological outcomes and survival in children post-cardiac arrest.
Introduction:
Therapeutic hypothermia (TH) improves neurological outcome in adults after ventricular fibrillation cardiac arrest and in neonates with hypoxic ischemic encephalopathy. The effect of TH in children is under investigation.
Objectives:
To assess the feasibility, efficacy and safety of a pilot program of TH in pediatric cardiac arrest.
Material And Methods:
Prospective study in a pediatric intensive care unit. An external cooling method with a servo system was used on all patients according to an established protocol. Values expressed as median (IQ range).
Results:
Six patients were included, of whom 5 had an out of hospital cardiac arrest. The mean age was 33 months (16-120) and Glasgow coma scale 6 (4-7). The T° prior to the induction of TH was 39.2° C (39.1-39.4). The median T° used was 34.0° C (33.5-34.8° C), which was reached in 4h. (3-7) after the start and maintained for 48h. (45-54). The rewarming was carried out over a period of 14h. (12-16). Hypokalemia was the most common adverse event found. Five patients survived to hospital discharge with a Glasgow Coma Scale of 13 (11-14). At 6 months follow up the Pediatric Cerebral Performance Category score was ≤ 2 in three patients.
Conclusion:
In this pilot study, the use of mild therapeutic hypothermia with a protocol that included rapid sequence induction with an external surface cooling technique was feasible, effective and safe in children with cardiac arrest.
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