Children who remained unconscious after out-of-hospital cardiac arrest had similar survival rates and cognitive functioning if they received therapeutic hypothermia or therapeutic normothermia, according to a randomized trial.
Lead researcher Frank W. Moler, MD, of the University of Michigan in Ann Arbor, and colleagues published their findings online in the New England Journal of Medicine on April 25.
The researchers defined therapeutic hypothermia as a target temperature of 33 degrees Celsius and therapeutic normothermia as a target temperature of 36.8 degrees Celsius. Previous studies found that therapeutic hypothermia was superior to therapeutic normothermia in adults and improved neurologic outcomes.
Each year, more than 6,000 children in the U.S. have out-of-hospital cardiac arrest, which researchers said is often associated with death or poor long-term functional outcomes.
In this study, researchers randomized 295 patients from pediatric intensive care units at 36 children’s hospitals in the U.S. and Canada between Sept. 1, 2009 and Dec. 31, 2012. Children were eligible for inclusion if they were older than 48 hours and younger than 18 years old and had a cardiac arrest requiring chest compressions for at least two minutes. They were also required to have remained in mechanical ventilation after their circulation returned.
The median age of patients was 2 years old, and approximately two-thirds were male. The median time from the return of circulation to the initiation of treatment was 5.9 hours in the hypothermia group and 5.8 hours in the normothermia group.
The primary outcome was survival 12 months after cardiac arrest and a score of 70 or higher on the Vineland Adaptive Behavior Scale, second edition. The researchers found 20 percent of patients in the hypothermia group and 12 percent of patients in the normothermia group met the criteria. The difference was not statistically significant.
After a year, 38 percent of children in the hypothermia group and 29 percent of children in the normothermia group were alive, which did not represent a statistically significant difference.