Therapeutic Hypothermia after In-Hospital Cardiac Arrest in Children

被引：210

作者：

Moler, F. W. ^{[1
]}

Silverstein, F. S. ^{[1
]}

Holubkov, R. ^{[3
]}

Slomine, B. S. ^{[4
,5
]}

Christensen, J. R. ^{[4
,5
]}

Nadkarni, V. M. ^{[8
]}

Meert, K. L. ^{[2
]}

Browning, B. ^{[3
]}

Pemberton, V. L. ^{[7
]}

Page, K. ^{[3
]}

Gildea, M. R. ^{[3
]}

Scholefield, B. R. ^{[11
]}

Shankaran, S. ^{[2
]}

Hutchison, J. S. ^{[15
]}

Berger, J. T. ^{[16
]}

Ofori-Amanfo, G. ^{[17
]}

Newth, C. J. L. ^{[18
]}

Topjian, A. ^{[8
]}

Bennett, K. S. ^{[3
]}

Koch, J. D. ^{[23
]}

Pham, N. ^{[25
]}

Chanani, N. K. ^{[25
]}

Pineda, J. A. ^{[26
]}

Harrison, R. ^{[19
]}

Dalton, H. J. ^{[27
]}

Alten, J. ^{[28
]}

Schleien, C. L. ^{[29
]}

Goodman, D. M. ^{[31
]}

Zimmerman, J. J. ^{[32
]}

Bhalala, U. S. ^{[6
]}

Schwarz, A. J. ^{[20
]}

Porter, M. B. ^{[33
]}

Shah, S. ^{[34
]}

Fink, E. L. ^{[9
]}

McQuillen, P. ^{[21
]}

Wu, T. ^{[24
]}

Skellett, S. ^{[12
]}

Thomas, N. J. ^{[10
]}

Nowak, J. E. ^{[35
]}

Baines, P. B. ^{[13
]}

Pappachan, J. ^{[14
]}

Mathur, M. ^{[22
]}

Lloyd, E. ^{[36
]}

van der Jagt, E. W. ^{[30
]}

Dobyns, E. L. ^{[37
]}

Meyer, M. T. ^{[38
]}

Sanders, R. C., Jr. ^{[39
]}

Clark, A. E. ^{[3
]}

Dean, J. M. ^{[3
]}

机构：

[1] Univ Michigan, Ann Arbor, MI 48109 USA

[2] Wayne State Univ, Detroit, MI USA

[3] Univ Utah, Salt Lake City, UT USA

[4] Kennedy Krieger Inst, Baltimore, MD USA

[5] Johns Hopkins Univ, Baltimore, MD USA

[6] Johns Hopkins Childrens Ctr, Baltimore, MD USA

[7] NHLBI, Bldg 10, Bethesda, MD 20892 USA

[8] Childrens Hosp Philadelphia, Philadelphia, PA 19104 USA

[9] Univ Pittsburgh, Med Ctr, Pittsburgh, PA USA

[10] Penn State Childrens Hosp, Hershey, PA USA

[11] Birmingham Childrens Hosp, Birmingham, W Midlands, England

[12] Great Ormond St Hosp Sick Children, London, England

[13] Alder Hey Childrens Hosp, Liverpool, Merseyside, England

[14] Southampton Univ Hosp, Southampton, Hants, England

[15] Hosp Sick Children, Toronto, ON, Canada

[16] Childrens Natl Med Ctr, Washington, DC 20010 USA

[17] Duke Childrens Hosp, Durham, NC USA

[18] Childrens Hosp Los Angeles, Los Angeles, CA 90027 USA

[19] Univ Calif Los Angeles, Mattel Childrens Hosp, Los Angeles, CA USA

[20] Childrens Hosp Orange Cty, Orange, CA 92668 USA

[21] Univ Calif San Francisco, Benioff Childrens Hosp, San Francisco, CA 94143 USA

[22] Loma Linda Univ, Childrens Hosp, Loma Linda, CA 92350 USA

[23] Univ Texas Southwestern Med Sch, Childrens Med Ctr Dallas, Dallas, TX USA

[24] Univ Texas Hlth Sci Ctr San Antonio, San Antonio, TX 78229 USA

[25] Childrens Healthcare Atlanta, Atlanta, GA USA

[26] Washington Univ, St Louis, MO USA

[27] Phoenix Childrens Hosp, Phoenix, AZ USA

[28] Childrens Hosp Alabama, Birmingham, AL USA

[29] Columbia Univ, Childrens Hosp New York, Med Ctr, New York, NY USA

[30] Univ Rochester, Med Ctr, Golisano Childrens Hosp, Rochester, NY 14642 USA

[31] Robert Lurie Childrens Hosp Chicago, Chicago, IL USA

[32] Seattle Childrens Hosp, Seattle, WA USA

[33] Univ Louisville, Kosair Childrens Hosp, Louisville, KY 40292 USA

[34] Univ Tennessee, Ctr Hlth Sci, Memphis, TN 38163 USA

[35] Childrens Hosp & Clin Minnesota, Minneapolis, MN USA

[36] Nationwide Childrens Hosp, Columbus, OH USA

[37] Childrens Hosp Colorado, Aurora, CO USA

[38] Med Coll Wisconsin, Milwaukee, WI 53226 USA

[39] Arkansas Childrens Hosp, 800 Marshall St, Little Rock, AR 72202 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2017年 / 376卷 / 04期

关键词：

AMERICAN-HEART-ASSOCIATION; HYPOXIC-ISCHEMIC ENCEPHALOPATHY; TRAUMATIC BRAIN-INJURY; WHOLE-BODY HYPOTHERMIA; CARDIOPULMONARY-RESUSCITATION; GUIDELINES UPDATE; CARE; EXPERIENCE; HYPERTHERMIA; SURVIVAL;

D O I：

10.1056/NEJMoa1610493

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Targeted temperature management is recommended for comatose adults and children after out-of-hospital cardiac arrest; however, data on temperature management after in-hospital cardiac arrest are limited. METHODS In a trial conducted at 37 children's hospitals, we compared two temperature interventions in children who had had in-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose children older than 48 hours and younger than 18 years of age were randomly assigned to therapeutic hypothermia (target temperature, 33.0 degrees C) or therapeutic normothermia (target temperature, 36.8 degrees C). The primary efficacy outcome, survival at 12 months after cardiac arrest with a score of 70 or higher on the Vineland Adaptive Behavior Scales, second edition (VABS-II, on which scores range from 20 to 160, with higher scores indicating better function), was evaluated among patients who had had a VABS-II score of at least 70 before the cardiac arrest. RESULTS The trial was terminated because of futility after 329 patients had undergone randomization. Among the 257 patients who had a VABS-II score of at least 70 before cardiac arrest and who could be evaluated, the rate of the primary efficacy outcome did not differ significantly between the hypothermia group and the normothermia group (36% [48 of 133 patients] and 39% [48 of 124 patients], respectively; relative risk, 0.92; 95% confidence interval [CI], 0.67 to 1.27; P=0.63). Among 317 patients who could be evaluated for change in neurobehavioral function, the change in VABS-II score from baseline to 12 months did not differ significantly between the groups (P = 0.70). Among 327 patients who could be evaluated for 1-year survival, the rate of 1-year survival did not differ significantly between the hypothermia group and the normothermia group (49% [81 of 166 patients] and 46% [74 of 161 patients], respectively; relative risk, 1.07; 95% CI, 0.85 to 1.34; P = 0.56). The incidences of blood-product use, infection, and serious adverse events, as well as 28-day mortality, did not differ significantly between groups. CONCLUSIONS Among comatose children who survived in-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a favorable functional outcome at 1 year. (Funded by the National Heart, Lung, and Blood Institute; THAPCA-IH ClinicalTrials.gov number, NCT00880087.)

引用

页码：318 / 329

页数：12

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