Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events

Kathleen Meert; Russell Telford; Richard Holubkov; Beth S Slomine; James R Christensen; J Michael Dean; Frank W Moler; Therapeutic Hypothermia after Paediatric Cardiac Arrest (THAPCA) Trial Investigators

doi:10.1016/j.resuscitation.2016.09.026

Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events

Resuscitation. 2016 Dec:109:40-48. doi: 10.1016/j.resuscitation.2016.09.026. Epub 2016 Oct 11.

Authors

Kathleen Meert¹, Russell Telford², Richard Holubkov², Beth S Slomine³, James R Christensen³, J Michael Dean², Frank W Moler⁴; Therapeutic Hypothermia after Paediatric Cardiac Arrest (THAPCA) Trial Investigators

Affiliations

¹ Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Boulevard, Detroit, MI 48201, USA. Electronic address: kmeert@med.wayne.edu.
² University of Utah, 295 Chipeta Way, P. O. Box 581289, Salt Lake City, UT 84158, USA.
³ Kennedy Krieger Institute, Johns Hopkins University, 707 North Broadway, Baltimore, MD 21205, USA.
⁴ University of Michigan, CS Mott Children's Hospital, 1540 East Hospital Drive, Ann Arbor, MI 48109, USA.

PMID: 27737774
PMCID: PMC5124384
DOI: 10.1016/j.resuscitation.2016.09.026

Abstract

Objective: To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial.

Methods: Fifty-four infants (48h to <1year of age) with ALTE who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation were included. Infants were randomised to therapeutic hypothermia (33°C) (n=26) or therapeutic normothermia (36.8°C) (n=28) within six hours of return of circulation. Outcomes included 12-month survival with Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score ≥70, 12-month survival, change in VABS-II score from pre-arrest to 12 months post-arrest, and select safety measures.

Results: Amongst infants with pre-arrest VABS-II ≥70 (n=52), there was no difference in 12-month survival with VABS-II ≥70 between therapeutic hypothermia and therapeutic normothermia groups (2/25 (8.0%) vs. 1/27 (3.7%); relative risk 2.16; 95% confidence interval 0.21-22.38, p=0.60). Amongst all evaluable infants (n=53), the change in VABS-II score from pre-arrest to 12 months post-arrest did not differ (p=0.078) between therapeutic hypothermia and therapeutic normothermia groups, nor did 12-month survival (5/26 (19.2%) vs. 1/27 (3.7%); relative risk 5.19; 95% confidence interval 0.65-41.50, p=0.10).

Conclusions: Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644).

Keywords: Apparent life threatening event; Cardiac arrest; Functional outcome; Mortality; Sudden infant death syndrome; Therapeutic hypothermia.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Research Support, N.I.H., Extramural

MeSH terms

Cardiopulmonary Resuscitation*
Coma / etiology
Coma / therapy*
Female
Heart Massage
Humans
Hypothermia, Induced / methods*
Infant
Male
Out-of-Hospital Cardiac Arrest / complications
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00878644

Abstract

Publication types

MeSH terms

Associated data

Grants and funding