Published online before print March 9, 2009, doi: 10.1161/CIRCULATIONAHA.108.791384
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(Circulation. 2009;119:1492-1500.)
© 2009 American Heart Association, Inc.
Pediatric Cardiology |
Hypothermia Therapy After Pediatric Cardiac Arrest
From the Department of Anaesthesia, Division of Pediatric Intensive Care (D.R.D.), Children’s Hospital of Eastern Ontario and University of Ottawa, Ottawa, Ontario, Canada; Department of Critical Care Medicine, The Hospital for Sick Children and Interdepartmental Division of Critical Care Medicine, University of Toronto (D.R.D., C.S.P., R.F., D.J.B., J.S.H.), Toronto, Ontario, Canada; Department of Anaesthesia (D.R.D., D.J.B.), The Hospital for Sick Children, Toronto, Ontario, Canada; Chalmers Research Group (I.G.), Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada; Cardiac Intensive Care Unit (A.H.), Great Ormond Street Hospital for Children, NHS Trust and the Institute of Child Health, London, United Kingdom; CHU mère-enfant Sainte-Justine (J.L., M.T.), Pediatric Intensive Care Division, Department of Pediatrics, Montréal, Québec, Canada; University of Alberta and Department of Pediatrics, Division of Pediatric Intensive Care (A.J.), Stollery Children’s Hospital, Edmonton, Alberta, Canada; Department of Pediatrics, Division of Pediatric Critical Care (K.C.), McMaster Children’s Hospital, Hamilton, Ontario, Canada; and Neuroscience and Mental Health Research Program (J.S.H.), Hospital for Sick Children Research Institute, Toronto, Ontario, Canada.
Correspondence to James S. Hutchison, Department of Critical Care Medicine, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8. E-mail jamie.hutchison{at}sickkids.ca
Received May 8, 2008; accepted December 8, 2008.
Background— Hypothermia therapy improves mortality and functional outcome after cardiac arrest and birth asphyxia in adults and newborns. The effect of hypothermia therapy in infants and children with cardiac arrest is unknown.
Methods and Results— A 2-year, retrospective, 5-center study was conducted, and 222 patients with cardiac arrest were identified. Seventy-nine (35.6%) of these patients met eligibility criteria for the study (age >40 weeks postconception and <18 years, cardiac arrest >3 minutes in duration, survival for 
12 hours after return of circulation, and no birth asphyxia). Twenty-nine (36.7%) of these 79 patients received hypothermia therapy and were cooled to 33.7±1.3°C for 20.8±11.9 hours. Hypothermia therapy was associated with higher mortality (P=0.009), greater duration of cardiac arrest (P=0.005), more resuscitative interventions (P<0.001), higher postresuscitation lactate levels (P<0.001), and use of extracorporeal membrane oxygenation (P<0.001). When adjustment was made for duration of cardiac arrest, use of extracorporeal membrane oxygenation, and propensity scores by use of a logistic regression model, no statistically significant differences in mortality were found (P=0.502) between patients treated with hypothermia therapy and those treated with normothermia. Also, no differences in hypothermia-related adverse events were found between groups.
Conclusions— Hypothermia therapy was used in resuscitation scenarios that are associated with greater risk of poor outcome. In an adjusted analysis, the effectiveness of hypothermia therapy was neither supported nor refuted. A randomized controlled trial is needed to rigorously evaluate the benefits and harms of hypothermia therapy after pediatric cardiac arrest.
CLINICAL PERSPECTIVE
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Clinical Summaries
Circulation 2009 119: 1457-1458.[Extract] [Full Text]