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 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. 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.