title: Evolution, safety and efficacy of targeted temperature management after pediatric cardiac arrest.
abstract: 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 °C) compared to standard temperature management (STM) (<38 °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 °C). Prior to ILCOR guidance adoption in January 2007, TTM was used infrequently (4/25; 16%). Following adoption, TTM (32-34 °C) use increased significantly (34/48; 71% Chi(2); p < 0.0001). TTM (32-34 °C) and STM (<38 °C) groups were similar at baseline. TTM (32-34 °C) was associated with bradycardia and hypotension compared to STM (<38 °C). TTM (32-34 °C) reduced episodes of hyperthermia (>38 °C) in the 1st 24h; however, excessive hypothermia (<32 °C) and hyperthermia (>38 °C) occurred in both groups up to 72 h, and all patients (n = 11) experiencing temperature <32 °C died. The study was underpowered to determine a difference in hospital survival (34% (TTM (32-34 °C)) versus 23% (STM (<38 °C)); p = 0.284). However, the TTM (32-34 °C) group had a significantly longer PICU length of stay.
  
  
  CONCLUSIONS
  TTM (32-34 °C) was feasible but associated with bradycardia, hypotension, and increased length of stay in PICU. Temperature <32 °C had a universally grave prognosis. Larger studies are required to assess effect on survival.
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK; School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, UK. Electronic address: Barney.scholefield@bch.nhs.uk.
authors.forename: Barnaby R
authors.initials: BR
authors.lastname: Scholefield
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Morris
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
authors.forename: Heather P
authors.initials: HP
authors.lastname: Duncan
authors.affiliation: Clinical Trials Unit, University of Warwick, Coventry CV4 7AL, UK; Academic Department of Anesthesia, Critical Care and Resuscitation, Heart of England NHS Foundation Trust, B9 5SS, UK.
authors.forename: Gavin D
authors.initials: GD
authors.lastname: Perkins
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
authors.forename: Jessica
authors.initials: J
authors.lastname: Gosney
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Skone
authors.affiliation: Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham B4 6NH, UK.
authors.forename: Victoria
authors.initials: V
authors.lastname: Sanders
authors.affiliation: School of Clinical and Experimental Medicine, University of Birmingham, Birmingham B15 2TT, UK; Academic Department of Anesthesia, Critical Care and Resuscitation, Heart of England NHS Foundation Trust, B9 5SS, UK; Department of Anaesthesiology, The Second Affiliated Hospital & Yuying Children Hospital of Wenzhou Medical University, Wenzhou, China.
authors.forename: Fang
authors.initials: F
authors.lastname: Gao
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000379:methods*; D007036:Hypothermia, Induced / Q000379:methods*; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013696:Temperature; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Observational study; Out-of-hospital cardiac arrest; Pediatric critical care; Targeted temperature management; Therapeutic hypothermia