title: Therapeutic hypothermia and outcomes in paediatric out-of-hospital cardiac arrest: A nationwide observational study.
abstract: This study aimed to analyse the association between mild therapeutic hypothermia (MTH) and outcomes in paediatric patients who survived out-of-hospital cardiac arrest (OHCA) by using their initial electrocardiogram (ECG) rhythm, which is the key factor used to predict prognosis in paediatric OHCA.
  
  
  
  This cross-sectional observational study utilised the registry of paediatric OHCA patients who survived to admission from 2008 to 2014 in the national OHCA database. MTH was defined as all cooling methods applied after the return of spontaneous circulation. Primary and secondary outcomes were survival to discharge and good neurologic recovery, respectively. Multivariable logistic regression analysis with an interaction term between MTH and the initial ECG at the scene was conducted to calculate adjusted odds ratios (AORs) and 95% confidence intervals (CIs) after adjusting for potential confounders.
  
  
  
  Among the 663 enrolled patients, the rates of survival to discharge and good neurological recovery in the MTH and non-MTH groups were similar, at 48.1% vs. 40.2% (P=0.17, AOR 1.05 [0.59-1.88]) and 22.2% vs. 8.7% (P=0.45, AOR 1.22 [0.59-2.51]). In the interaction model, the AORs of MTH in shockable rhythm vs. non-shockable rhythm for survival to discharge (AOR 0.62 [0.15-2.52] vs. 1.17 [0.62-2.2]) and good neurological recovery (0.42 [0.12-1.45] vs. 2.22 [0.83-5.98]) were not significantly different.
  
  
  
  MTH and the effect of MTH across the initial ECG at the scene were not significantly associated with survival or good neurologic recovery in paediatric OHCA survivors.
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: taketime97@gmail.com.
authors.forename: Ikwan
authors.initials: I
authors.lastname: Chang
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: yhkwak@snuh.org.
authors.forename: Young Ho
authors.initials: YH
authors.lastname: Kwak
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: shinsangdo@medimail.co.kr.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: ironlyj@gmail.com.
authors.forename: Eui Jung
authors.initials: EJ
authors.lastname: Lee
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: arendt75@gmail.com.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
authors.affiliation: Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: birdbeak@naver.com.
authors.forename: Do Kyun
authors.initials: do K
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy*; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012307:Risk Factors; D016019:Survival Analysis
keywords: Cardiac arrest; Child; Electrocardiography; Therapeutic hypothermia