Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest.

Scholefield, Barnaby R, Morris, Kevin P, Duncan, Heather P, Perkins, Gavin D, Gosney, Jessica, Skone, Richard, Sanders, Victoria and Gao, Fang (2015) Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest. Resuscitation, 92. pp. 19-25. ISSN 1873-1570. This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs

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Official URL: http://www.resuscitationjournal.com/article/S0300-...

Abstract

BACKGROUND

It is unknown whether targeted temperature management (TTM) improves survival after pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the evolution, safety and efficacy of TTM (32-34°C) compared to standard temperature management (STM) (<38°C).

METHODS

Retrospective, single center cohort study. Patients aged >one day up to 16 years, admitted to a UK Paediatric Intensive Care Unit (PICU) after OHCA (January 2004-December 2010). Primary outcome was survival to hospital discharge; efficacy and safety outcomes included: application of TTM, physiological, hematological and biochemical side effects.

RESULTS

Seventy-three patients were included. Thirty-eight patients (52%) received TTM (32-34°C). Prior to ILCOR guidance adoption in January 2007, TTM was used infrequently (4/25; 16%). Following adoption, TTM (32-34°C) use increased significantly (34/48; 71% Chi(2); p<0.0001). TTM (32-34°C) and STM (<38°C) groups were similar at baseline. TTM (32-34°C) was associated with bradycardia and hypotension compared to STM (<38°C). TTM (32-34°C) reduced episodes of hyperthermia (>38°C) in the 1st 24h; however, excessive hypothermia (<32°C) and hyperthermia (>38°C) occurred in both groups up to 72h, and all patients (n=11) experiencing temperature <32°C died. The study was underpowered to determine a difference in hospital survival (34% (TTM (32-34°C)) versus 23% (STM (<38°C)); p=0.284). However, the TTM (32-34°C) group had a significantly longer PICU length of stay.

CONCLUSIONS

TTM (32-34°C) was feasible but associated with bradycardia, hypotension, and increased length of stay in PICU. Temperature <32°C had a universally grave prognosis. Larger studies are required to assess effect on survival.

Item Type: Article
Additional Information: This article is accessible to all HEFT staff and students via NICE journals and databases http://www.nice.org.uk/about/what-we-do/evidence-services/journals-and-databases by using their HEFT Athens login IDs
Subjects: WG Cardiovascular system. Cardiology
WS Paediatrics. Child health
Divisions: Clinical Support > Anaesthetics
Clinical Support > Critical Care
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Depositing User: Mrs Yolande Brookes
Date Deposited: 19 Jun 2015 14:23
Last Modified: 19 Jun 2015 15:02
URI: http://www.repository.uhblibrary.co.uk/id/eprint/979

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