Faculty Collaboration Database

Targeted Temperature Management After Pediatric Cardiac Arrest Due To Drowning: Outcomes and Complications. Pediatr Crit Care Med 2016 Aug;17(8):712-20

Date

07/01/2016

Pubmed ID

27362855

Pubmed Central ID

PMC5123789

DOI

10.1097/PCC.0000000000000763

Scopus ID

2-s2.0-84976576318 (requires institutional sign-in at Scopus site)   23 Citations

Abstract

OBJECTIVE: To describe outcomes and complications in the drowning subgroup from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital trial.

DESIGN: Exploratory post hoc cohort analysis.

SETTING: Twenty-four PICUs.

PATIENTS: Pediatric drowning cases.

INTERVENTIONS: Therapeutic hypothermia versus therapeutic normothermia.

MEASUREMENTS AND MAIN RESULTS: An exploratory study of pediatric drowning from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital trial was conducted. Comatose patients aged more than 2 days and less than 18 years were randomized up to 6 hours following return-of-circulation to hypothermia (n = 46) or normothermia (n = 28). Outcomes assessed included 12-month survival with a Vineland Adaptive Behavior Scale score of greater than or equal to 70, 1-year survival rate, change in Vineland Adaptive Behavior Scale-II score from prearrest to 12 months, and select safety measures. Seventy-four drowning cases were randomized. In patients with prearrest Vineland Adaptive Behavior Scale-II greater than or equal to 70 (n = 65), there was no difference in 12-month survival with Vineland Adaptive Behavior Scale-II score of greater than or equal to 70 between hypothermia and normothermia groups (29% vs 17%; relative risk, 1.74; 95% CI, 0.61-4.95; p = 0.27). Among all evaluable patients (n = 68), the Vineland Adaptive Behavior Scale-II score change from baseline to 12 months did not differ (p = 0.46), and 1-year survival was similar (49% hypothermia vs 42%, normothermia; relative risk, 1.16; 95% CI, 0.68-1.99; p = 0.58). Hypothermia was associated with a higher prevalence of positive bacterial culture (any blood, urine, or respiratory sample; 67% vs 43%; p = 0.04); however, the rate per 100 days at risk did not differ (11.1 vs 8.4; p = 0.46). Cumulative incidence of blood product use, serious arrhythmias, and 28-day mortality were not different. Among patients with cardiopulmonary resuscitation durations more than 30 minutes or epinephrine doses greater than 4, none had favorable Pediatric Cerebral Performance Category outcomes (≤ 3).

CONCLUSIONS: In comatose survivors of out-of-hospital pediatric cardiac arrest due to drowning, hypothermia did not result in a statistically significant benefit in survival with good functional outcome or mortality at 1 year, as compared with normothermia. High risk of culture-proven bacterial infection was observed in both groups.

Author List

Moler FW, Hutchison JS, Nadkarni VM, Silverstein FS, Meert KL, Holubkov R, Page K, Slomine BS, Christensen JR, Dean JM, Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial Investigators

Authors

Michael T. Meyer MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Martin K. Wakeham MD Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Cardiopulmonary Resuscitation
Child
Child, Preschool
Coma
Combined Modality Therapy
Drowning
Female
Follow-Up Studies
Humans
Hypothermia, Induced
Infant
Infant, Newborn
Intention to Treat Analysis
Male
Near Drowning
Out-of-Hospital Cardiac Arrest
Prospective Studies
Survival Rate
Treatment Outcome