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

Barney Scholefield; Kevin P Morris; Heather P Duncan; Gavin D Perkins; Jessica Gosney; Richard Skone; Victoria Sanders; Fang Gao

doi:10.1016/j.resuscitation.2015.04.007

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

Barney Scholefield, Kevin P Morris, Heather P Duncan, Gavin D Perkins, Jessica Gosney, Richard Skone, Victoria Sanders, Fang Gao

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

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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% Chi²; 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 24 h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, 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.

Original language	English
Pages (from-to)	19-25
Number of pages	7
Journal	Resuscitation
Volume	92
Early online date	20 Apr 2015
DOIs	https://doi.org/10.1016/j.resuscitation.2015.04.007
Publication status	Published - Jul 2015

Bibliographical note

Keywords

Pediatric critical care
Therapeutic hypothermia
Targeted temperature management
Observational study
Out-of-hospital cardiac arrest

Access to Document

10.1016/j.resuscitation.2015.04.007

Scholefield_et_al_Evolution_safety_efficacy_Resuscitation_2015
NOTICE: this is the author’s version of a work that was accepted for publication. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published as Scholefield BR, Morris KP, Duncan HP, Perkins GD, Gosney J, Skone R, Sanders V, Gao F, Evolution, safety and efficacy of targeted temperature management after paediatric cardiac arrest., Resuscitation (2015), http://dx.doi.org/10.1016/j.resuscitation.2015.04.007
Accepted author manuscript, 716 KBLicence: Other (please specify with Rights Statement)

Cite this

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title = "Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest",

abstract = "BackgroundIt 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).MethodsRetrospective, 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.ResultsSeventy-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% Chi2; 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 24 h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, 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.ConclusionsTTM (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.",

keywords = "Pediatric critical care, Therapeutic hypothermia, Targeted temperature management, Observational study, Out-of-hospital cardiac arrest",

author = "Barney Scholefield and Morris, {Kevin P} and Duncan, {Heather P} and Perkins, {Gavin D} and Jessica Gosney and Richard Skone and Victoria Sanders and Fang Gao",

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month = jul,

doi = "10.1016/j.resuscitation.2015.04.007",

language = "English",

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T1 - Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest

AU - Scholefield, Barney

AU - Morris, Kevin P

AU - Duncan, Heather P

AU - Perkins, Gavin D

AU - Gosney, Jessica

AU - Skone, Richard

AU - Sanders, Victoria

AU - Gao, Fang

PY - 2015/7

Y1 - 2015/7

N2 - BackgroundIt 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).MethodsRetrospective, 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.ResultsSeventy-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% Chi2; 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 24 h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, 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.ConclusionsTTM (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.

AB - BackgroundIt 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).MethodsRetrospective, 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.ResultsSeventy-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% Chi2; 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 24 h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, 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.ConclusionsTTM (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.

KW - Pediatric critical care

KW - Therapeutic hypothermia

KW - Targeted temperature management

KW - Observational study

KW - Out-of-hospital cardiac arrest

U2 - 10.1016/j.resuscitation.2015.04.007

DO - 10.1016/j.resuscitation.2015.04.007

M3 - Article

C2 - 25906941

SN - 0300-9572

VL - 92

SP - 19

EP - 25

JO - Resuscitation

JF - Resuscitation

ER -

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

Abstract

Bibliographical note

Keywords

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