Survey of the use of therapeutic hypothermia post cardiac arrest

Abstract

Objectives: Therapeutic hypothermia improves neurological outcome in adults after ventricular fibrillation cardiac arrest and neonates with hypoxic ischaemic encephalopathy. There is currently no clinical research to support its use in the paediatric population. This survey aims to ascertain current practice in the UK, and attitudes and opinions to guide the feasibility of a UK multicentre, randomised, controlled trial of therapeutic hypothermia after cardiac arrest in children (The Cold-PACK Post Arrest Cooling in Kids study).

Methods: Anonymous survey of UK paediatric intensive care consultants (n=149).

Results: A total of 113 (76%) of 149 surveys were returned; 65% responded that they do not know if therapeutic hypothermia improves survival after cardiac arrest. Despite this, 48% 'always' or 'often' use therapeutic hypothermia after return of spontaneous circulation following cardiac arrest in children. Among those who never use therapeutic hypothermia (33%) the commonest explanation given was 'not enough research evidence' (91%). With respect to the dose of therapeutic hypothermia the median duration of cooling used is 24-48 h (range 4-72 h) and median target temperature 34°C to 35°C (range 32°C to 37°C); 68% target a temperature range higher than that applied in the published adult and neonatal studies (33±1°C). There was strong support for a trial of therapeutic hypothermia being ethical (89%) and using deferred consent (85%).

Conclusions: Wide variation in UK practice in the use of therapeutic hypothermia and a state of clinical equipoise is demonstrated by this survey, which shows important support for UK multicentre collaboration in a future trial of therapeutic hypothermia after cardiac arrest.