Friday, November 18, 2016

Title: Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications

Authors: Moler FW, et al

Journal: Pediatric Critical Care Medicine, Aug 2016

This was a sub-group analysis of drowning patients from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial. This multi-center trial was a first of its kind randomized trial evaluating outcome in pediatric patients following cardiac arrest, comparing therapeutic hypothermia and normothermia. This study is in response to adult evidence over past decade showing improved neurologic outcome following cardiac arrest when therapeutic hypothermia is protocolized. Unfortunately, to date, the pediatric data has not shown this effect.

Study design: exploratory subgroup analysis

Study population: 

  • Pediatric patients 48 hours to 18 years of age
  • Cardiac arrest due to drowning
  • GCS < 5 on arrival (criteria from original trial)
  • 65 total patients analysed
    • 41 hypothermia group
    • 24 normothermia group
    • Median age 2.9 years, majority male
    • Bystander witnessed in 17%
    • Bystander CPR in 85%
    • Initial rhythm asystole in 65% and VF/VT in 3%
  • Targeted temperature management performed for 120 hours in all patients
    • Hypothermia group: 33C for 48 h, rewarmed over 16 hrs to 36.8C for remainder
    • Normothermia group: 36.8C maintained for duration
  • No difference in long-term neurologic outcome between groups
  • No difference in 12 month mortality between groups
  • These findings similar to outcomes from all-causes in the full trial
While these results unfortunately do not reveal any new hope for improving outcome in these patients, this trial at least adds evidence to an otherwise mysterious topic.  Currently, international guidelines call for initiating therapeutic hypothermia in drowning patients with cardiac arrest, but these recommendation are currently base on very little evidence.