Therapeutic hypothermia after pediatric cardiac arrest

Introduction: Therapeutic hypothermia (TH) improves neurological outcome in adults after ventricular fibrillation cardiac arrest and in neonates with hypoxic ischemic encephalopathy. The effect of TH in children is under investigation. Objectives: To assess the feasibility, efficacy and safety of a pilot program of TH in pediatric cardiac arrest. Material and methods: Prospective study in a pediatric intensive care unit. An external cooling method with a servo system was used on all patients according to an established protocol. Values expressed as median (IQ range). Results: Six patients were included, of whom 5 had an out of hospital cardiac arrest. The mean age was 33 months (16-120) and Glasgow coma scale 6 (4-7). The T degrees prior to the induction of TH was 39.2 degrees C (39.1-39.4). The median T degrees used was 34.0 degrees C (33.5-34.8 degrees C), which was reached in 4h. (3-7) after the start and maintained for 48h. (45-54). The rewarming was carried out over a period of 14h. (12-16). Hypokalemia was the most common adverse event found. Five patients survived to hospital discharge with a Glasgow Coma Scale of 13(11-14). At 6 months follow up the Pediatric Cerebral Performance Category score was <= 2 in three patients. Conclusion: In this pilot study, the use of mild therapeutic hypothermia with a protocol that included rapid sequence induction with an external surface cooling technique was feasible, effective and safe in children with cardiac arrest. (C) 2011 Asociacion Espanola de Pediatria. Published by Elsevier Espana, S.L. All rights reserved.