Therapeutic Hypothermia in Paediatric Cardiac Arrest

In this week's FLICNA Journal Club, Andrew Fester from Birmingham Children's Hospital will be discussing the evidence for therapeutic hypothermia after paediatric cardiac arrest.

Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S | display-authors=etal (2021) Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med 384 (24):2283-2294. DOI: 10.1056/NEJMoa2100591 PMID: 34133859. 

References

• Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S | display-authors=etal (2021) Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. N Engl J Med 384 (24):2283-2294. DOI: 10.1056/NEJMoa2100591 PMID: 34133859.
• Pallmann P, Bedding AW, Choodari-Oskooei B, Dimairo M, Flight L, Hampson LV | display-authors=etal (2018) Adaptive designs in clinical trials: why use them, and how to run and report them. BMC Med 16 (1):29. DOI: 10.1186/s12916-018-1017-7 PMID: 29490655.
  • Extract: " Our focus, however, is on the interpretation and reporting of results from adaptive design trials, which we consider vital for anyone involved in medical research"
• Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Pediatric Critical Care Medicine: March 2019 - Volume 20 - Issue 3
  • Extract: hypothermia should be avoided in the treatment of  severe TBI to improve outcome but may be used to reduce ICP as a later-tier therapy at a level III recommendation. And not a Level II as before, since none of the studies of higher class had ICP control as a primary outcome and there were several safety concerns that were identified.
• Mourvillier B, Tubach F, van de Beek D, Garot D, Pichon N, Georges H | display-authors=etal (2013) Induced hypothermia in severe bacterial meningitis: a randomized clinical trial. JAMA 310 (20):2174-83. DOI: 10.1001/jama.2013.280506 PMID: 24105303.
  • Extract: Moderate hypothermia did not improve outcome in patients with severe bacterial meningitis and may even be harmful"
• Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346 (8):549-56. DOI: 10.1056/NEJMoa012689 PMID: 11856793
  • Extract: "In patients who have been successfully resuscitated after cardiac arrest due to ventricular fibrillation, therapeutic mild hypothermia increased the rate of a favorable neurologic outcome and reduced mortality."
• Jacobs SE, Berg M, Hunt R, Tarnow-Mordi WO, Inder TE, Davis PG (2013) Cooling for newborns with hypoxic ischaemic encephalopathy. Cochrane Database Syst Rev (1):CD003311. DOI: 10.1002/14651858.CD003311.pub3 PMID: 23440789
  • Extract: "There is evidence from the 11 randomised controlled trials included in this systematic review (N = 1505 infants) that therapeutic hypothermia is beneficial in term and late preterm newborns with hypoxic ischaemic encephalopathy"
• Lascarrou JB, Meziani F, Le Gouge A, Boulain T, Bousser J, Belliard G | display-authors=etal (2015) Therapeutic hypothermia after nonshockable cardiac arrest: the HYPERION multicenter, randomized, controlled, assessor-blinded, superiority trial. Scand J Trauma Resusc Emerg Med 23 ():26. DOI: 10.1186/s13049-015-0103-5 PMID: 25882712
  • Extract: "The HYPERION trial is a multicenter, randomized, controlled, assessor-blinded, superiority trial that may provide an answer to an issue of everydayrelevance, namely, whether TTM is beneficial in comatose patients resuscitated after nonshockable cardiac arrest"
• Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C | display-authors=etal (2013) Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med 369 (23):2197-206. DOI: 10.1056/NEJMoa1310519 PMID: 24237006
  • Extract: "In unconscious survivors of out-of-hospital cardiac arrest of presumed cardiac cause, hypothermia at a targeted temperature of 33°C did not confer a benefit as compared with a targeted temperature of 36°C"
• Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H | display-authors=etal (2021) European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 161 ():220-269. DOI: 10.1016/j.resuscitation.2021.02.012 PMID: 33773827
  • Extract: " The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations"