See also the thapcaoh study for analogous data regarding outofhospital pediatric cardiac arrest objectives. Referral to early steps program referral to pediatric neurologydevelopmental pediatricianpediatric neuropsychologist. Therapeutic hypothermia to be initiated per protocol as soon as possible after patient meets entry criteria and should be considered as proven to be therapeutic only if commenced in the first 6 hours of life. A large randomized trial of therapeutic hypothermia for children with ohca showed no difference in outcomes whether a. Sufficient hemodynamic stability that cooling would not cause hemodynamic collapse. Many inhospital cardiac arrests have noncardiac causes, and because the use of therapeutic hypothermia has not been studied to a significant extent. Under the th protocol, patient temperature was targeted to be 33. During maintenance of hypothermia, 78% of measures were within target t 32c34c. An established extracorporeal membrane oxygenation protocol promotes survival in extreme hypothermia. Induced therapeutic hypothermia after pediatric cardiac arrest is an important. From concept inception in 2002 until trial initiation in 2009, 7 years were required to plan and operationalize the therapeutic hypothermia after pediatric cardiac arrest trials. Therapeutic hypothermia after inhospital cardiac arrest. This has not been demonstrated or confirmed by current evidence. Hypothermia after cardiac arrest perelman school of.
Pdf therapeutic hypothermia after cardiac arrest researchgate. Recently, the use of therapeutic hypothermia has gradually occupied an. Therapeutic hypothermia is also being explored in the pediatric population. State some pediatric considerations related to therapeutic hypothermia 6.
A potential benefit of therapeutic hypothermia in perinatal asphyxia was suggested by edwards in 1824 edwards, 1824. Hypothermia and neonatal encephalopathy american academy. State the newest evidence on stroke and therapeutic hypothermia 7. Process and outcome indicators were monitored to evaluate the effectiveness and feasibility of hypothermia intervention in this setting. Demographics and other clinical data ere collected. For pediatric patients, please see pediatric icu guideline for therapeutic hypothermia.
The therapeutic hypothermia after pediatric cardiac arrest trials will determine whether therapeutic hypothermia improves survival with good neurobehavioral outcome, as assessed by the vineland adaptive behavior scales second edi. Therapeutic hypothermia protocol for cardiac arrest patient selection patients who present to the emergency department ed or critical care unit ccu after cardiac arrest in or out of hospital who have a return of spontaneous circulation rosc and have the following conditions should be considered for this protocol. For pediatric patients with cardiac diagnoses and ihca in settings with existing extracorporeal membrane oxygenation protocols, ecpr may be considered. Pdf therapeutic hypothermia has been used for millennia, but in recent. Obtain a core temperature via esophageal, bladder or rectal temperature probe.
Thapca therapeutic hypothermia after pediatric cardiac. Therapeutic hypothermia in the postresuscitation patient. Therapeutic hypothermia frequent vital sign sheet cooling the patient in the first 4 hours 1. Therapeutic hypothermia is a standard of care for infants. Two national institute of child health and human develop. Postarrest therapeutic hypothermia in pediatric patients. We conclude that we still lack scientific support as a firsttier therapy for the use of therapeutic hypothermia in tbi patients for both adults and children, but it may still be an option as a secondtier therapy for refractory intracranial hypertension.
A 2014 uk survey found that 79% 33 of 42 of responding neonatal units routinely withheld enteral nutrition during cooling. Page the strokeicu consult service beeper 20202 for the initial. Notify trauma teampediatric surgery service level i trauma. The college and the american academy of pediatrics aap. Newborn critical care center nccc clinical guidelines. There is a separate study for children who arrest in the hospital thapcaih and children who arrest out of the hospital thapcaoh. Therapeutic hypothermia after pediatric cardiac arrest in.
The american heart association recommends consideration of hypothermia in the pediatric patient who has a cardiac arrest. Therapeutic hypothermia after inhospital cardiac arrest in. Therapeutic hypothermia after paediatric cardiac arrest. Therapeutic hypothermia does not appear to provide a survival or improved neurological benefit in both studies, no difference in survival, function at 12 months postarrest, blood product use, infection rates. More recently, the benefits of induced therapeutic hypothermia have been.
Do not begin cooled infusion until cooling devices are assembled 2. Hypothermia therapy after traumatic brain injury in children. Therapeutic hypothermia translates from ancient history in to. Therapeutic hypothermia after paediatric cardiac arrest cpccrn. Therapeutic hypothermia protocol therapeutic hypothermia was induced and maintained for 72 hours. Therapeutic hypothermia in pediatric and neonatal resuscitation. Therapeutic hypothermia after inhospital cardiac arrest in children. Pediatric cardiology, cardiac arrest, therapeutic hypothermia, congenital heart disease, seizures, intensive care introduction therapeutic hypothermia th has been studied as a neuroprotective therapy to minimize brain injury and improve neurologic outcome after hypoxicischemic encephalopathy hie in several patient groups. To evaluate the efficacy of therapeutic hypothermia compared to therapeutic normothermia at increasing 12 month survival rates in comatose infants and children who were resuscitated after an inhospital cardiac arrest. The therapeutic hypothermia after pediatric cardiac arrest trials will determine whether therapeutic hypothermia improves survival with good neurobehavioral outcome, as assessed by the. A complete list of investigators in the therapeutic hypothermia after pediatric cardiac arrest outofhospital thapcaoh trial is provided in the supplementary appendix, available at. The implementation of cooling needs to be performed at centers that have the capability to manage medically. This is a pdf file of an unedited manuscript that has been accepted for publication.
The strokeicu consult service should be consulted to assess and document the comatose state prior to or immediately after the initiation of hypothermia. Therapeutic hypothermia after outofhospital cardiac. Pediatric cardiac arrest and neonatal hypoxicischemic encephalopathy. Efficacy outcome selection in the therapeutic hypothermia. Michael feldman discuss the removal of atropine from the peaasystole algorithm, the indications and dangers of adenosine in widecomplex tachycardias, pressors as a bridge to transvenous pacing in unstable bradycardias, and the key elements of post cardiac arrest care. Optimising nutrition during therapeutic hypothermia adc. The egyptians, greeks, and romans first recommended induced cooling for. The rationale, study design, outcome selection process, protocol summary, 12 month pilot vanguard phase and individual trial outcomes were previously. The effect of hypothermia therapy in infants and children with cardiac arrest is. Therapeutic hypothermia protocol for cardiac arrest. A standard surface cooling protocol achieved rapid induction of hypothermia after. Induction of prehospital therapeutic hypothermia after resuscitation from nonventricular fibrillation cardiac arrest. Should children who have a cardiac arrest be treated with. Therapeutic hypothermia or therapeutic normothermia.
Induction of therapeutic hypothermia after cardiac arrest in prehospital patients using icecold ringers solution. Michael misch discusses the management controversies around a challenging pediatric drowning and hypothermia case, including rewarming, oxygenation, cpr, ecmo and. Hypothermia and neonatal encephalopathy american academy of. Therapeutic hypothermia to be initiated per protocol as soon as possible after patient meets entry criteria and should be considered as proven to be therapeutic only. Mar 10, 2014 these mechanisms may counteract neuroprotective effects of therapeutic hypothermia. Moderate, severe or extreme hypothermia 32 c, or 90 f rectal, vesical thermistor bladder catheter, and confirmed esophageally core temperature. A standard surface cooling protocol achieved rapid induction of hypothermia after pediatric cardiac arrest.
Induced hypothermia post cardiac arrest with rosc in 2002, the new england journal published two well designed studies 1,2 showing dramatically improved outcomes when patients are actively cooled after resuscitation from v. Thapca therapeutic hypothermia after pediatric cardiac arrest. There is little evidence to inform provision of enteral or parenteral nutrition to infants with hypoxic ischaemic encephalopathy hie during and soon after therapeutic hypothermia. Discuss the common adverse events of therapeutic hypothermia and the practical approaches for these adverse events 5. Therapeutic hypothermia th is an effective treatment in models of experimental brain injury, including cardiac arrest, ischemic stroke, and traumatic brain injury tbi. Rapid initiation of hypothermia, but at a maximum within six hours of rosc.
Guidelines the 2005 american heart association guidelines on. Rationale, timeline, study design, and protocol overview of. Induction and maintenance of therapeutic hypothermia after. The egyptians, greeks, and romans first recommended induced cooling for battleinflicted trauma and a. Infants selected for cooling must meet the criteria outlined in published clinical trials.
Natusolympic medical cool cap system or inspiration healthcaretecotherm neo was used for the cooling process. If greater than 34c, start therapeutic hypothermia. Clinical report hypothermia and neonatal encephalopathy. Post natal blood gas hypothermia outside the limits of controlled trials was premature.
Pdf prognosis following outofhospital cardiac arrest is generally poor, which is mostly. Therapeutic hypothermia translates from ancient history in. Jan 16, 2014 the two therapeutic hypothermia after pediatric cardiac arrest thapca trials 350 and 500 participants will determine whether, among children aged hypothermia protocol. Cooling for infants therapeutic hypothermia, some level 4 evidence suggests that survivors from outofhospital cardiac arrest of other causes may also benefit 9.
Critcases 5 pediatric drowning and hypothermia view larger image in this critcases blog a collaboration between stars air ambulance service, mike betzner and em cases, dr. In perinatal asphyxia in newborn kittens, hypothermia prolonged the duration of asphyxia required to terminate gasping. Fever should be avoided when caring for comatose children with rosc after ohca. Current literature does not support the routine utilization of hypothermia for conditions other than cardiac arrest callaway et al. Data from large randomized clinical trials indicate that therapeutic hypothermia, using either selective head cooling or systemic cooling, is an effective therapy for neonatal encephalopathy. Sep 27, 2016 the earliest recommendations for induced hypothermia can be traced back to the ancient world. Therapeutic hypothermia in children and adults with severe. Because some studies included infants born at 35 weeks ga, hypothermia should be considered if they meet other criteria. Initiate therapeutic hypothermia yes no findings from evaluation required for all evaluated performed 1. Ideally, neonates who have undergone therapeutic hypothermia should be followed closely until 2 year of age for developmental delays. Pdf therapeutic hypothermia after pediatric cardiac arrest. Hypothermia therapy after pediatric cardiac arrest aha journals. We switched from automatic mode to manual mode during rewarming so.
Targeted temperature management therapeutic hypothermia. Bladder lavage to be used only if cooling process not successful within 1530 minutes 9. The studied neonates underwent either selective head cooling shc or whole body cooling wbc. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. Therapeutic hypothermia after outofhospital cardiac arrest. Inducing mild therapeutic hypothermia in selected patients surviving outof hospital. Hypothermia for newborns with hypoxicischemic encephalopathy. The study, entitled therapeutic hypothermia after pediatric cardiac arrest thapca, will evaluate whether regulating the body temperature will improve the outcome for children after cardiac arrest. Severe hypothermia may cause cardiac instability and rough handling of the patient theoretically can cause ventricular fibrillation. The earliest recommendations for induced hypothermia can be traced back to the ancient world. State the newest research studies on traumatic brain injury and therapeutic hypothermia. Pediatric drowning and hypothermia critcases em cases.
478 290 828 178 998 1397 685 1022 732 1576 1058 731 107 177 1147 494 1140 1431 1272 1336 259 437 1458 1483 563 116 646 1297 1178 647 64 636 1258 519 18 111 1419 313 1067 698 1140 1036 458 661 688 1156 824