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Post-arrest therapeutic hypothermia in pediatric patients with congenital heart disease
Henry H Cheng1, Satish K Rajagopal2, Arnold J Sansevere3
1Department of Cardiology, Boston Children's Hospital, United States.
Insights
Therapeutic hypothermia (TH) is safe and effective for pediatric patients with congenital heart disease (CHD) after cardiac arrest, potentially reducing seizure incidence. This neuroprotective therapy shows promise for improving outcomes in this vulnerable population.
Area of Science:
- Pediatric Cardiology
- Neurocritical Care
- Cardiovascular Research
Background:
- Therapeutic hypothermia (TH) is established for neonatal hypoxic-ischemic encephalopathy but its efficacy in other pediatric populations, particularly those with congenital heart disease (CHD), remains less defined.
- Patients with CHD face high risks of cardiac arrest and subsequent neurodevelopmental impairments, necessitating effective neuroprotective strategies.
- The study addresses the need for improved neurologic outcomes in pediatric post-cardiac arrest patients with CHD.
Purpose of the Study:
- To evaluate the safety and efficacy of therapeutic hypothermia (TH) in pediatric patients with congenital heart disease (CHD) following cardiac arrest.
- To compare outcomes between CHD patients treated with TH and those receiving standard care (controls).
Main Methods:
- A comparative study involving pediatric patients with CHD who experienced cardiac arrest.
- Patients treated with TH (target temperature 33.5°C) within 18 months of protocol initiation were compared to historical and contemporary controls not receiving TH.
- Data collected included temperature, safety metrics (arrhythmia, bleeding), neurodiagnostics (EEG, neuroimaging), and survival rates.
Main Results:
- Thirty TH-treated arrest episodes and 51 control episodes were analyzed; groups were comparable in age, arrest duration, lactate, and ECMO-CPR use.
- TH group achieved significantly lower post-arrest temperatures (33.6°C vs 34.7°C).
- No significant differences were observed in safety measures, neuroimaging, or hospital survival between groups, but TH significantly reduced seizure incidence (4.0% vs 26.1%).
Conclusions:
- Therapeutic hypothermia (TH) can be safely and effectively administered to pediatric patients with congenital heart disease (CHD) following cardiac arrest.
- TH may play a role in decreasing the incidence of seizures in this patient population.
- Further research is warranted to fully elucidate the long-term neurodevelopmental benefits of TH in pediatric CHD patients post-arrest.
Background:
While therapeutic hypothermia (TH) is an effective neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy, TH has not been demonstrated to improve outcome in other pediatric populations. Patients with acquired or congenital heart disease (CHD) are at high risk of both cardiac arrest and neurodevelopmental impairments, and therapies are needed to improve neurologic outcome. The primary goal of our study was to compare safety/efficacy outcomes in post-arrest CHD patients treated with TH versus controls not treated with TH.
Methods:
Patients with CHD treated during the first 18 months after initiation of a post-arrest TH protocol (temperature goal: 33.5 °C) were compared to historical and contemporary post-arrest controls not treated with TH. Post-arrest data, including temperature, safety measures (e.g. arrhythmia, bleeding), neurodiagnostic data (EEG, neuroimaging), and survival were compared.
Results:
Thirty arrest episodes treated with TH and 51 control arrest episodes were included. The groups did not differ in age, duration of arrest, post-arrest lactate, or use of ECMO-CPR. The TH group's post-arrest temperature was significantly lower than control's (33.6 ± 0.2 °C vs 34.7 ± 0.5 °C, p < 0.001). There was no difference between the groups in safety/efficacy measures, including arrhythmia, infections, chest-tube output, or neuroimaging abnormalities, nor in hospital survival (TH 61.5% vs control 59.1%, p = NS). Significantly more controls had seizures than TH patients (26.1% vs. 4.0%, p = 0.04). Almost all seizures were subclinical and occurred more than 24 h post-arrest.
Conclusion:
Our data show that pediatric CHD patients who suffer cardiac arrest can be treated effectively and safely with TH, which may decrease the incidence of seizures.
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