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Therapeutic hypothermia after out-of-hospital cardiac arrest in children
Frank W Moler1, Faye S Silverstein, Richard Holubkov
1The authors' affiliations are listed in the Appendix.
Insights
Therapeutic hypothermia did not significantly improve survival with good functional outcomes in comatose children after cardiac arrest compared to normothermia. This study highlights the limited benefit of hypothermia in pediatric cardiac arrest survivors.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Neurology
Background:
- Therapeutic hypothermia is recommended for comatose adults post-cardiac arrest.
- Limited data exists on its efficacy and safety in pediatric populations.
- Out-of-hospital cardiac arrest (OHCA) in children presents unique challenges.
Purpose of the Study:
- To evaluate the efficacy of therapeutic hypothermia versus normothermia in comatose children after OHCA.
- To assess the impact on survival with favorable functional outcomes at 12 months.
- To compare secondary outcomes including survival rates and adverse events.
Main Methods:
- A randomized trial involving 38 children's hospitals.
- Comatose pediatric patients (older than 2 days, younger than 18 years) after OHCA were assigned to hypothermia (33.0°C) or normothermia (36.8°C) within 6 hours.
- Primary outcome: survival at 12 months with a Vineland Adaptive Behavior Scales, second edition (VABS-II) score ≥70, evaluated in patients with pre-arrest VABS-II score ≥70.
Main Results:
- No significant difference in the primary outcome between hypothermia and normothermia groups (20% vs. 12%, P=0.14) among eligible patients.
- Overall 1-year survival was similar (38% vs. 29%, P=0.13).
- Incidences of infection, arrhythmias, blood product use, and 28-day mortality were comparable between groups.
Conclusions:
- Therapeutic hypothermia did not demonstrate a significant benefit over therapeutic normothermia for comatose children surviving OHCA.
- The findings suggest current hypothermia protocols may not improve functional outcomes in this pediatric population.
- Further research may be needed to optimize temperature management strategies for pediatric cardiac arrest.
Background:
Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited.
Methods:
We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0°C) or therapeutic normothermia (target temperature, 36.8°C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest.
Results:
A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality.
Conclusions:
In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute and others; THAPCA-OH ClinicalTrials.gov number, NCT00878644.).
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