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

Scholefield, Barnaby R and Morris, Kevin P and Duncan, Heather P and Perkins, Gavin D and Gosney, Jessica and Skone, Richard and 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
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 19 Jun 2015 14:23
Last Modified: 19 Jun 2015 15:02
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/979

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