title: Induction and maintenance of therapeutic hypothermia after pediatric cardiac arrest: efficacy of a surface cooling protocol.
abstract: OBJECTIVE
  To assess the feasibility, effectiveness, side effects, and adverse events associated with a standardized surface cooling protocol. Induced therapeutic hypothermia after pediatric cardiac arrest is an important intervention.
  
  
  METHODS
  Prospective intervention trial.
  
  
  METHODS
  Urban, tertiary care children's hospital.
  
  
  METHODS
  Twelve pediatric cardiac arrest survivors.
  
  
  METHODS
  Standardized surface cooling protocol.
  
  
  RESULTS
  Patients (age: median, 1.5 yrs; interquartile range, 0.5-6.25; cardiopulmonary resuscitation duration: median, 18 mins; interquartile range, 10-45) were cooled by a standard surface cooling protocol for rapid induction and maintenance of goal rectal temperature (T) 32°C-34°C for 24 hrs, with prospectively defined rescue protocols. Side effects and clinical interventions were recorded. Median time to rectal T ≤34°C was 1.5 (1, 1.5) hrs from cooling initiation and 6 (5, 6.5) hrs from arrest. T was documented every 30 mins. Maintenance target T 32°C-34°C was attained in 78% (414 of 531) of measurements, overshoot hypothermia <32°C in 15% (81 of 531), and overshoot hyperthermia >34°C in 7% (36 of 531). Mean bias between rectal vs. esophageal T was -0.42°C (95% confidence interval, -0.49 to -0.35), and between rectal and bladder T was 0.16°C (95% confidence interval, 0.11-0.22). Side effects observed included: hypokalemia <3.0 mEq/L in 67% of patients and bradycardia <2% for age in 58%. There were no episodes of bleeding or ventricular tachyarrhythmia that required treatment. Six (50%) of 12 patients survived to discharge.
  
  
  CONCLUSIONS
  A standard surface cooling protocol achieved rapid induction of hypothermia after pediatric cardiac arrest. During maintenance of hypothermia, 78% of measures were within target T 32°C-34°C. Commonly employed temperature sites (esophageal, rectal, and bladder) were similar. Overshoot hypothermia and associated side effects were common, but there were no serious adverse events attributable to induced therapeutic hypothermia in this case series. Surface cooling protocols to induce and maintain therapeutic hypothermia after pediatric cardiac arrest are potentially feasible.
authors.affiliation: Department of Anesthesia, Critical Care, and Pediatrics, The Children's Hospital of Philadelphia (CHOP), University of Pennsylvania School of Medicine, Philadelphia, PA, USA. topjian@email.chop.edu
authors.forename: Alexis
authors.initials: A
authors.lastname: Topjian
authors.forename: Larissa
authors.initials: L
authors.lastname: Hutchins
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: DiLiberto
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Abend
authors.forename: Rebecca
authors.initials: R
authors.lastname: Ichord
authors.forename: Mark
authors.initials: M
authors.lastname: Helfaer
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
mesh_terms: D002648:Child; D002675:Child, Preschool; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods* / Q000592:standards; D007223:Infant; D008297:Male; D011446:Prospective Studies