Therapeutic hypothermia after cardiopulmonary resuscitation in a 4-month infant

Therapeutic hypothermia is currently recommended for adult comatose survivors of cardiac arrest and perinatal hypoxic-ischemic encephalopathy. By contrast, current international guidelines on cardiopulmonary resuscitation in children neither refute nor support therapeutic hypothermia. Here we report on a 4-month old infant who survived resuscitation for severe cardiopulmonary insufficiency without neurological impairments. The infant most probably experienced unwitnessed aspiration with subsequent severe cardiopulmonary insufficiency. This was paralleled by incidental hypothermia, i.e. a core body temperature of 32°C at time of resuscitation. The infant was transported to the pediatric intensive care unit and additional to state-of the art resuscitation therapy (e.g. vasopressors, pressure controlled intermittent mandatory ventilation) therapeutic hypothermia (core body temperature 32.0-34.0°C) was admininistered for additional 48 h to confer optimal neuroprotection. Subsequently, he was rewarmed (0.25°C per hour) and sedation was stopped at a core body temperature of 36°C. Chest X-ray at time of admission to the hospital revealed typical signs of severe aspiration, whereas transthoraic echocardiography, electrocardiography and ultrasound examination of the brain were without pathological findings. Likewise, magnetic resonance imaging of the head performed on days 3 and 32 after resuscitation revealed no signs of hypoxic brain damage and the child was discharged to foster care without neurological deficits 52 days after admission.