scholarly journals Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians

2018 ◽  
Vol 08 (02) ◽  
pp. 071-077 ◽  
Author(s):  
Marianne Gildea ◽  
Frank Moler ◽  
Kent Page ◽  
Victoria Pemberton ◽  
Richard Holubkov ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cardiac Arrest ◽  
Critical Care ◽  
Brain Injury ◽  
Clinical Outcomes ◽  
Therapeutic Hypothermia ◽  
Practice Patterns ◽  
Temperature Management ◽  
Pediatric Critical Care ◽  
Fever Management

AbstractThe Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) Trial showed therapeutic hypothermia, versus normothermia, did not significantly improve 1-year survival with good neurobehavioral outcome. Our survey of pediatric critical care physicians, designed to assess the use of targeted temperature management (TTM) after publication of the main THAPCA-OH Trial results, found most respondents were aware of trial results, and over 90% agreed THAPCA-OH was well-designed with important clinical outcomes. While most respondents reported TTM usage consistent with THAPCA-OH results in different patient scenarios, 15% did not select TTM for fever management. Since trials prior to THAPCA-OH established that fever is harmful following brain injury, the continued incomplete adoption of TTM warrants further research on challenges and facilitators to the adoption of clinical trial findings.

scholarly journals Efficacy of Targeted Temperature Management after Pediatric Cardiac Arrest: A Meta-Analysis of 2002 Patients

2021 ◽  
Vol 10 (7) ◽  
pp. 1389
Author(s):  
Wojciech Wieczorek ◽  
Jarosław Meyer-Szary ◽  
Milosz J. Jaguszewski ◽  
Krzysztof J. Filipiak ◽  
Maciej Cyran ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Adverse Events ◽  
Therapeutic Hypothermia ◽  
Hospital Discharge ◽  
Fixed Effects ◽  
Meta Analysis ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
One Year

Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

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