Therapeutic Hypothermia after Out-of-Hospital Cardiac Arrest in Children

被引：315

作者：

Moler, Frank W. ^{[1
]}

Silverstein, Faye S. ^{[1
]}

Holubkov, Richard ^{[3
]}

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

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

Nadkarni, Vinay M. ^{[8
]}

Meert, Kathleen L. ^{[2
]}

Clark, Amy E. ^{[3
]}

Browning, Brittan ^{[3
]}

Pemberton, Victoria L. ^{[7
]}

Page, Kent ^{[3
]}

Shankaran, Seetha ^{[2
]}

Hutchison, Jamie S. ^{[11
]}

Newth, Christopher J. L. ^{[12
]}

Bennett, Kimberly S. ^{[3
]}

Berger, John T. ^{[17
]}

Topjian, Alexis ^{[8
]}

Pineda, Jose A. ^{[18
]}

Koch, Joshua D. ^{[19
,20
]}

Schleien, Charles L. ^{[22
]}

Dalton, Heidi J. ^{[24
]}

Ofori-Amanfo, George ^{[26
]}

Goodman, Denise M. ^{[27
]}

Fink, Ericka L. ^{[9
]}

McQuillen, Patrick ^{[14
]}

Zimmerman, Jerry J. ^{[28
]}

Thomas, Neal J. ^{[10
]}

van der Jagt, Elise W. ^{[23
]}

Porter, Melissa B. ^{[29
]}

Meyer, Michael T. ^{[30
]}

Harrison, Rick ^{[13
]}

Nga Pham ^{[31
]}

Schwarz, Adam J. ^{[15
]}

Nowak, Jeffrey E. ^{[32
]}

Alten, Jeffrey ^{[33
]}

Wheeler, Derek S. ^{[34
]}

Bhalala, Utpal S. ^{[6
]}

Lidsky, Karen ^{[35
]}

Lloyd, Eric ^{[36
]}

Mathur, Mudit ^{[16
]}

Shah, Samir ^{[37
]}

Wu, Theodore ^{[21
]}

Theodorou, Andreas A. ^{[25
]}

Sanders, Ronald C., Jr. ^{[38
]}

Dean, J. Michael ^{[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, Bethesda, MD 20892 USA

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

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

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

[11] Hosp Sick Children, Toronto, ON M5G 1X8, Canada

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

[13] Mattel Childrens Hosp UCLA, Los Angeles, CA USA

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

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

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

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

[18] Washington Univ, St Louis, MO 63130 USA

[19] Childrens Med Ctr Dallas, Dallas, TX USA

[20] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

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

[22] Columbia Univ, Med Ctr, New York Presbyterian Morgan Stanley Childrens Ho, New York, NY USA

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

[24] Phoenix Childrens Hosp, Phoenix, AZ USA

[25] Diamond Childrens Med Ctr, Tucson, AZ USA

[26] Duke Childrens Hosp & Hlth Ctr, Durham, NC USA

[27] Ann & Robert H Lurie Childrens Hosp Chicago, Chicago, IL 60611 USA

[28] Seattle Childrens Hosp, Seattle, WA USA

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

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

[31] Childrens Healthcare Atlanta, Atlanta, GA USA

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

[33] Childrens Alabama, Birmingham, AL USA

[34] Cincinnati Childrens Hosp Med Ctr, Cincinnati, OH 45229 USA

[35] Rainbow Babies & Childrens Hosp, Cleveland, OH 44106 USA

[36] Nationwide Childrens Hosp, Columbus, OH USA

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

[38] Arkansas Childrens Hosp, Little Rock, AR 72202 USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2015年 / 372卷 / 20期

关键词：

HYPOXIC-ISCHEMIC ENCEPHALOPATHY; AMERICAN-HEART-ASSOCIATION; TRAUMATIC BRAIN-INJURY; WHOLE-BODY HYPOTHERMIA; CARE; CARDIOPULMONARY; RESUSCITATION; TEMPERATURE; EXPERIENCE; EPIDEMIOLOGY;

D O I：

10.1056/NEJMoa1411480

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but data about this intervention in children are limited. METHODS We conducted this trial of two targeted temperature interventions at 38 children's hospitals involving children who remained unconscious after out-of-hospital cardiac arrest. Within 6 hours after the return of circulation, comatose patients who were older than 2 days 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 Vineland Adaptive Behavior Scales, second edition (VABS-II), score of 70 or higher (on a scale from 20 to 160, with higher scores indicating better function), was evaluated among patients with a VABS-II score of at least 70 before cardiac arrest. RESULTS A total of 295 patients underwent randomization. Among the 260 patients with data that could be evaluated and who had a VABS-II score of at least 70 before cardiac arrest, there was no significant difference in the primary outcome between the hypothermia group and the normothermia group (20% vs. 12%; relative likelihood, 1.54; 95% confidence interval [CI], 0.86 to 2.76; P=0.14). Among all the patients with data that could be evaluated, the change in the VABS-II score from baseline to 12 months was not significantly different (P=0.13) and 1-year survival was similar (38% in the hypothermia group vs. 29% in the normothermia group; relative likelihood, 1.29; 95% CI, 0.93 to 1.79; P=0.13). The groups had similar incidences of infection and serious arrhythmias, as well as similar use of blood products and 28-day mortality. CONCLUSIONS In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at 1 year.

引用

页码：1898 / 1908

页数：11

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[21] Early Clinical Predictors of Neurological Outcome in Children With Asphyxial Out-of-Hospital Cardiac Arrest Treated With Therapeutic Hypothermia [J].

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