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. 2013 Feb 28;2013(2):CD009442.
doi: 10.1002/14651858.CD009442.pub2.

Hypothermia for neuroprotection in children after cardiopulmonary arrest

Barnaby Scholefield  1 , Heather Duncan, Paul Davies, Fang Gao Smith, Khalid Khan, Gavin D Perkins, Kevin Morris
Affiliations

Hypothermia for neuroprotection in children after cardiopulmonary arrest

Barnaby Scholefield et al. Cochrane Database Syst Rev. .

Abstract

Background: Cardiopulmonary arrest in paediatric patients often results in death or survival with severe brain injury. Therapeutic hypothermia, lowering of the core body temperature to 32°C to 34°C, may reduce injury to the brain in the period after the circulation has been restored. This therapy has been effective in neonates with hypoxic ischaemic encephalopathy and adults after witnessed ventricular fibrillation cardiopulmonary arrest. The effect of therapeutic hypothermia after cardiopulmonary arrest in paediatric patients is unknown.

Objectives: To assess the clinical effectiveness of therapeutic hypothermia after paediatric cardiopulmonary arrest.

Search methods: We searched the Cochrane Anaesthesia Review Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 11); Ovid MEDLINE (1966 to December 2011); Ovid EMBASE (1980 to December 2011); Ovid CINAHL (1982 to December 2011); Ovid BIOSIS (1923 to December 2011); and Web of Science (1945 to December 2011). We searched the trials registry databases for ongoing trials. We also contacted international experts in therapeutic hypothermia and paediatric critical care to locate further published and unpublished studies.

Selection criteria: We planned to include randomized and quasi-randomized controlled trials comparing therapeutic hypothermia with normothermia or standard care in children, aged 24 hours to 18 years, after paediatric cardiopulmonary arrest.

Data collection and analysis: Two authors independently assessed articles for inclusion.

Main results: We found no studies that satisfied the inclusion criteria. We found four on-going randomized controlled trials which may be available for analysis in the future. We excluded 18 non-randomized studies. Of these 18 non-randomized studies, three compared therapeutic hypothermia with standard therapy and demonstrated no difference in mortality or the proportion of children with a good neurological outcome; a narrative report was presented.

Authors' conclusions: Based on this review, we are unable to make any recommendations for clinical practice. Randomized controlled trials are needed and the results of on-going trials will be assessed when available.

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Conflict of interest statement

Barnaby Scholefield has received a travel grant to attend a hypothermia conference from the Paediatric Intensive Care Society, UK and financial support through employment to perform the systematic review from Birmingham Children's Hospital, UK. He also organised a trainee intensive care educational symposium with small (less than £700) corporate sponsorship from companies selling hypothermia cooling devices.

Gavin Perkins has received reimbursement of expenses to attend and speak at CPR conferences and to develop national and international CPR guidelines. He has received payment from Elsevier Publishing for his role as an editor for the journal Resuscitation.

Professor Khalid Khan's research is largely funded by public bodies in the UK and European Union. He has participated in research projects where pharmaceutical companies (for example Ferring Pharmaceuticals) have contributed a grant. He has received honoraria and has had travel and accommodation expenses covered or reimbursed for speaking at meetings from pharmaceutical companies (for example Ferring Pharmaceuticals) and from various Colleges, Universities and Societies. He receives royalties on his books from publishers (Hodder Arnold; Huber). His institution has received sponsorship for organising educational meetings (Alere; Ethicon; Ferring Pharmaceuticals; Hologic; Leo‐Pharma; Preglem/Quintiles; Viforpharma). He is in a Partnership where he offers advice on several matters including medical research and negligence. He provides expert reports in medical negligence cases for which a fee is paid by instructing solicitors.

All other authors: none known.

Figures

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Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to studies excluded from this review

Abend 2009 {published data only}
    1. Abend NS, Topjian A, Ichord R, Herman ST, Helfaer M, Donnelly M, et al. Electroencephalographic monitoring during hypothermia after pediatric cardiac arrest. Neurology 2009;72(22):1931‐40. [PUBMED: 19487651] - PMC - PubMed
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Kessler 2011 {published data only}
    1. Kessler SK, Topjian AA, Gutierrez‐Colina AM, Ichord RN, Donnelly M, Nadkarni VM, et al. Short‐term outcome prediction by electroencephalographic features in children treated with therapeutic hypothermia after cardiac arrest. Neurocritical Care 2011;14(1):37‐43. [PUBMED: 20890677] - PMC - PubMed
Kobr 2011 {published data only}
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Moler 2011 {published data only}
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References to ongoing studies

NCT00754481 {published data only}
    1. NCT00754481. Hypothermia for Cardiac Arrest in Paediatrics (HypCAP). www.clinicatrials.gov NCT00754481.
NCT00797680 {published data only}
    1. NCT00797680. Duration of Hypothermia for Neuroprotection After Paediatric Cardiac Arrest. www.clinicaltrials.gov NCT00797680.
NCT00878644 {published data only}
    1. NCT00878644. Therapeutic Hypothermia to Improve Survival After Cardiac Arrest in Paediatric Patients‐(THAPCA‐OH) (Out of Hospital) Trial. www.clinicaltrials.gov NCT00878644.
NCT00880087 {published data only}
    1. NCT00880087. Therapeutic Hypothermia to Improve Survival After Cardiac Arrest in Paediatric Patients‐(THAPCA‐IH) (In Hospital) Trial. www.clinicaltrials.gov NCT00880087.

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