Therapeutic hypothermia after out-of-hospital cardiac arrest in children
Journal of the Intensive Care Society 2016, Vol. 17(1) 73–75 ! The Intensive Care Society 2016 Reprints and permissions: sagepub.co.uk/ journalsPermissions.nav DOI: 10.1177/1751143715623450 jics.sagepub.com
In children who suffer out of hospital cardiac arrest, targeted hypothermia at 33.0 C confers no benefit when compared to targeted normothermia at 36.8 C. Level of evidence: 2B (RCT with wide CIs)
Lead author: Frank W Moler; [email protected]
Inclusion criteria: At least 2 min of cardiopulmonary resuscitation (CPR) following cardiac arrest and requiring mechanical ventilation following ROSC. Exclusion criteria: Not randomised within 6 h of cardiac arrest. Motor score of 5 or 6 on Glasgow Coma Scale (GCS). Decision made to withhold aggressive treatment. Cardiac arrest associated with major trauma.
Three-part clinical question
Patient: Children older than 48 h and younger than 18 years old who had an out-of-hospital cardiac arrest with at least 2 min of chest compressions and requiring mechanical ventilation after return of spontaneous circulation (ROSC). Intervention: Targeted temperature management at 33.0 C vs 36.8 C within 6 h of ROSC for 48 h. Rewarmed to 36.8 C over 16 h. Outcome: Primary: Survival at 12 months with a Vineland Adaptive Behaviour Scales, second edition (VABS-II) score of 70 or higher. Secondary: Survival at 12 months and change in neurobehavioural function based on pre-cardiac arrest and 12 month VABS-II.
Children eligible for inclusion were randomly assigned to one of the two targeted temperature management groups in a 1:1 ratio with use of permuted blocks stratified according to clinical centre and age at entry (