Post-arrest temperature management
Until recently, no therapy had been shown to be efficacious for neuroprotection and survival in humans post cardiac arrest (CA). In 2002, two adult RCTs of mild therapeutic hypothermia (TH) after VF or VT out-of-hospital CA reported improved neurological outcome and survival. In 2005, two moderate sized and one small RCTs of TH for newborns with HIE, all reported improved long term neurological outcome. Studies have shown that being too cold (<32°C) is not effective for neuroprotection nor is being too warm (>37.5°C).
Recent guidelines recommend that hypothermia therapy be used in adults who remain comatose following resuscitation from ventricular arrhythmia–induced cardiac arrest.
No similar data are currently available for the benefits of TH following paediatric cardiac arrest. Based on the laboratory, adult and neonatal study the ILCOR Advisory Statement recommends:
“Until additional pediatric data become available, clinicians should tailor therapy for individual patients on the basis of their assessment of the risks and benefits of hypothermia.”
There is currently an international trial for the use of TH in post CA in children that is actively recruiting. Until the result of this trial becomes available, there is no compelling evidence to change the practice on our PICU to include TH. In the meantime, tighter temperature control should be practised in these patients.