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Randomized Controlled Trial
. 2019 Feb:135:88-97.
doi: 10.1016/j.resuscitation.2018.12.012. Epub 2018 Dec 17.

Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes

Frank W Moler  1 , Faye S Silverstein  2 , Vinay M Nadkarni  3 , Kathleen L Meert  4 , Samir H Shah  5 , Beth Slomine  6 , James Christensen  6 , Richard Holubkov  7 , Kent Page  7 , J Michael Dean  7 ; THAPCA Trial Investigators
Affiliations
Randomized Controlled Trial

Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes

Frank W Moler et al. Resuscitation. 2019 Feb.

Abstract

Aim: Although recent out-of-hospital cardiac arrest (CA) trials found no benefits of hypothermia versus normothermia targeted temperature management, preclinical models suggest earlier timing of hypothermia improves neuroprotective efficacy. This study investigated whether shorter time to goal temperature was associated with better one-year outcomes in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial.

Methods: Patients were classified by tertiles of time to attain assigned goal temperature range (32-34°C or 36-37.5°C) following ROSC. Outcomes in the first tertile ("earlier") Group 1 were compared with second and third tertiles ("later") Group 2. Separate analyses were, additionally, completed for hypothermia and normothermia intervention groups. Three one-year outcomes were examined: survival; Vineland Adaptive Behavior Scale (VABS-II) score≥70; and decrease in VABS-II≤15 points from baseline.

Results: In the entire cohort (n=281), median time from ROSC to goal temperature was 7.4 [IQR 6.2-9.7] hours: Group 1, 5.8 [IQR 5.2, 6.2] and Group 2, 8.8 [IQR 7.4, 10.4] h. Outcomes did not differ between these groups. For hypothermia subgroup, survival was lower in Group 1 than 2, [10/49(20%) versus 47/99(47%), p<0.002], with a trend toward fewer with VABS-II scores≥70 and change in VABS-II≤15 points (p=0.07-0.08). For normothermia subgroup, there was a trend toward higher survival in Group 1 than 2 [18/42(43%) versus 21/83(25%), p=0.065], but no differences in VABS-II-related measures. In multivariable logistic regression models, no difference in earlier and later groups or temperature intervention was observed.

Conclusion: We found no evidence that earlier time to goal temperature was associated with better outcomes.

Trial registration: ClinicalTrials.gov NCT00878644.

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Conflict of interest statement

Declaration of Conflict of Interest Statement:

Faye S. Silverstein: ‘Conflicts of interest: none’

Kent Page: ‘Conflicts of interest: none’

Richard Holubkov: ‘Conflicts of interest: none’

Beth S. Slomine: ‘Conflicts of interest: none’

Kathleen L. Meert: ‘Conflicts of interest: none’

James R. Christensen: ‘Conflicts of interest: none’

Samir Shah: ‘Conflicts of interest: none’

Vinay M. Nadkarni: ‘Conflicts of interest: none’

J. Michael Dean: ‘Conflicts of interest: none’

Frank W. Moler: ‘Conflicts of interest: none’

Figures

Figure 1.
Figure 1.. Time from ROSC to goal temperature range in THAPCA out of hospital trial.
First and second tertiles of the time in hours from ROSC to goal temperature range, by treatment group, were Hypothermia 6.7, 8.8; Normothermia 6.5, 8.6; Overall 6.6, 8.8.
See this image and copyright information in PMC

References

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