Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest

Background: It is unknown whether targeted temperature management (TTM) improves survival after pediatric out-of-hospital cardiac arrest (OHCA). The aim of this study was to assess the evolution, safety and efficacy of TTM (32-34 degrees C) compared to standard temperature management (STM) (<38 degrees C). Methods: Retrospective, single center cohort study. Patients aged >one day up to 16 years, admitted to a UK Paediatric Intensive Care Unit (PICU) after OHCA (January 2004 December 2010). Primary outcome was survival to hospital discharge; efficacy and safety outcomes included: application of TTM, physiological, hematological and biochemical side effects. Results: Seventy-three patients were included. Thirty-eight patients (52%) received TTM (32-34 degrees C). Prior to ILCOR guidance adoption in January 2007, TTM was used infrequently (4125; 16%). Following adoption, TTM (32-34 degrees C) use increased significantly (34148; 71% Chi(2); p < 0.0001). TTM (32-34 degrees C) and STM (<38 degrees C) groups were similar at baseline. TTM (32-34 degrees C) was associated with bradycardia and hypotension compared to STM (<38 degrees C). TTM (32-34 degrees C) reduced episodes of hyperthermia (>38 degrees C) in the 1st 24 h; however, excessive hypothermia (<32 degrees C) and hyperthermia (>38 degrees C) occurred in both groups up to 72 h, and all patients (n=11) experiencing temperature <32 degrees C died. The study was underpowered to determine a difference in hospital survival (34% (TTM (32-34 degrees C)) versus 23% (STM (<38 degrees C)); p = 0.284). However, the TTM (32-34 degrees C) group had a significantly longer PICU length of stay. Conclusions: TTM (32-34 degrees C) was feasible but associated with bradycardia, hypotension, and increased length of stay in PICU. Temperature <32 degrees C had a universally grave prognosis. Larger studies are required to assess effect on survival. (C) 2015 Elsevier Ireland Ltd. All rights reserved.