Therapeutic hypothermia in pediatric drowning

Short Attention Span Summary

TH strikes (out) again
Therapeutic hypothermia (TH) vs. normothermia did not improve survival or neurological outcome in pediatric drowning victims.  Infection and other complications were not worse in the TH group.

Spoon Feed
Pediatric drowning victims with ROSC, like other arrest victims, are treated best by keeping the temperature normal.  TH does not benefit.  EMCrit has the top 10 reasons not to cool to 33 Celsius.

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Abstract

Pediatr Crit Care Med. 2016 Aug;17(8):712-20. doi: 10.1097/PCC.0000000000000763.

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

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.

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.

PMID: 27362855 [PubMed - in process]