Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children
Related Experiment Video
Updated: Mar 8, 2026
In vitro Assessment of Myocardial Protection following Hypothermia-Preconditioning in a Human Cardiac Myocytes Model
Published on: October 27, 2020
Frank W Moler1, Faye S Silverstein1, Richard Holubkov1
1From the University of Michigan, Ann Arbor (F.W.M., F.S.S.), and Wayne State University, Detroit (K.L.M., S. Shankaran) - both in Michigan; University of Utah, Salt Lake City (R. Holubkov, B.B., K.P., M.R.G., K.S.B., A.E.C., J.M.D.); Kennedy Krieger Institute and Johns Hopkins University (B.S.S., J.R.C.) and Johns Hopkins Children's Center (U.S.B.), Baltimore, and the National Heart, Lung, and Blood Institute, Bethesda (V.L.P.) - both in Maryland; Children's Hospital of Philadelphia, Philadelphia (V.M.N., A.T.), University of Pittsburgh Medical Center, Pittsburgh (E.L.F.), and Penn State Children's Hospital, Hershey (N.J.T.) - all in Pennsylvania; Birmingham Children's Hospital, Birmingham (B.R.S.), Great Ormond Street Hospital, London (S. Skellett), Alder Hey Children's Hospital, Liverpool (P.B.B.), and University Hospital Southampton, Southampton (J.P.) - all in the United Kingdom; Hospital for Sick Children, Toronto (J.S.H.); Children's National Medical Center, Washington, DC (J.T.B.); Duke Children's Hospital, Durham, NC (G.O.-A.); Children's Hospital Los Angeles (C.J.L.N.) and Mattel Children's Hospital UCLA (R. Harrison), Los Angeles, Children's Hospital of Orange County, Orange (A.J.S.), University of California, San Francisco Benioff Children's Hospital, San Francisco (P.M.), and Loma Linda University Children's Hospital, Loma Linda (M.M.) - all in California; Children's Medical Center Dallas, University of Texas Southwestern Medical School, Dallas (J.D.K.); University of Texas Health Sciences Center at San Antonio, San Antonio (T.W.); Children's Healthcare of Atlanta, Atlanta (N.P., N.K.C.); Washington University, St. Louis (J.A.P.); Phoenix Children's Hospital, Phoenix, AZ (H.J.D.); the Children's Hospital of Alabama, Birmingham (J.A.); Children's Hospital of New York, Columbia University Medical Center, New York (C.L.S.), and Golisano Children's Hospital, University of Rochester Medical Center, Rochester (E.W.J.) - both in New York; Ann and Robert Lurie Children's Hospital of Chicago, Chicago (D.M.G.); Seattle Children's Hospital, Seattle (J.J.Z.); Kosair Children's Hospital, University of Louisville, Louisville, KY (M.B.P.); University of Tennessee Health Science Center, Memphis (S. Shah); Children's Hospital and Clinics of Minnesota, Minneapolis (J.E.N.); Nationwide Children's Hospital, Columbus, OH (E.L.); Children's Hospital Colorado, Aurora (E.L.D.); Medical College of Wisconsin, Milwaukee (M.T.M.); and Arkansas Children's Hospital, Little Rock (R.C.S.).
Insights
Therapeutic hypothermia did not improve survival outcomes in comatose children after in-hospital cardiac arrest compared to therapeutic normothermia. This study found no significant difference in functional recovery or survival rates at 12 months.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Neurology and neurocritical care
Background:
- Targeted temperature management (TTM) is recommended for comatose survivors of out-of-hospital cardiac arrest.
- Limited data exists regarding TTM effectiveness in pediatric patients following in-hospital cardiac arrest (IHCA).
- This study addresses the gap in understanding optimal post-IHCA temperature strategies for children.
Purpose of the Study:
- To compare the efficacy of therapeutic hypothermia versus therapeutic normothermia in comatose children after IHCA.
- To evaluate the primary outcome of survival at 12 months with favorable functional status (Vineland Adaptive Behavior Scales, second edition [VABS-II] score ≥70).
- To assess neurobehavioral function changes and survival rates between the two temperature interventions.
Main Methods:
- A randomized trial involving comatose children (older than 48 hours, younger than 18 years) after IHCA across 37 children's hospitals.
- Participants were assigned to either therapeutic hypothermia (target 33.0°C) or therapeutic normothermia (target 36.8°C) within 6 hours of return of circulation.
- The primary efficacy outcome was assessed using VABS-II scores at 12 months among patients with pre-existing VABS-II scores of at least 70.
Main Results:
- The trial was terminated early due to futility after randomizing 329 patients.
- No significant difference in the primary efficacy outcome was observed between the hypothermia and normothermia groups (36% vs. 39%, P=0.63).
- Survival rates at 1 year (49% vs. 46%, P=0.56) and changes in neurobehavioral function did not differ significantly between groups.
Conclusions:
- Therapeutic hypothermia did not demonstrate a significant benefit over therapeutic normothermia in improving survival with favorable functional outcomes at 1 year for comatose children post-IHCA.
- Incidences of blood-product use, infection, serious adverse events, and 28-day mortality were similar between the two temperature management strategies.
- The findings suggest that therapeutic normothermia may be a suitable alternative to hypothermia in this patient population.
Background:
Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited.
Methods:
In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours 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 score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest.
Results:
The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P=0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P=0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups.
Conclusions:
Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087 .).
More Related Videos
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:29Decreased Body Temperature
01:22Methods of reducing fever
Pharmacological Methods of Reducing Fever:
01:21Cardiopulmonary Resuscitation I: Adult