NIH: In a multicenter, international study of infants and children who
suffered cardiac arrest while in the hospital, NIH-funded researchers
have found that body cooling, or therapeutic hypothermia, is no more
effective than actively keeping the body at a normal temperature, or
therapeutic normothermia.
The study is the first to look exclusively at in-hospital cardiac
arrests in infants and children in order to compare the two temperature
treatments. Earlier trials involving adults who went into cardiac arrest
outside of a hospital had found that therapeutic hypothermia improved
survival and brain function. However, recent trials in adults and
children did not find such improvements when compared with patients
whose temperature was actively maintained in a normal temperature range
to prevent fever.
Current guidelines recommend either treatment for out-of-hospital
cardiac arrests in children, as both methods have resulted in equal
rates of survival and prevention of brain injury. But out-of-hospital
cardiac arrests have different causes and outcomes than in-hospital
ones, and the findings of the new study could inform new guidelines for
treatment of the latter.
The study included 329 patients between the ages of 2 days and 18
years old who had sustained cardiac arrest while in a hospital. The
researchers randomly divided them into two groups and found that
children in the group treated with therapeutic hypothermia had the same
survival rates and neurobehavioral functioning a year later as those
treated by keeping the body at normal temperature.
The research—funded by the National Heart, Lung, and Blood Institute
(NHLBI), part of the National Institutes of Health—was presented at the
annual meeting of the Society for Critical Care Medicine and published
simultaneously in the January 24 issue of the New England Journal of
Medicine.
The study is part of the Therapeutic Hypothermia after Pediatric
Cardiac Arrest (THAPCA) trials, the largest examination to date of
therapeutic hypothermia in children other than newborns for any health
condition.