Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events

Kathleen Meert, Russell Telford, Richard Holubkov, Beth S. Slomine, James R. Christensen, J. Michael Dean, Frank W. Moler

Research output: Research - peer-reviewArticle

Abstract

Objective To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. Methods Fifty-four infants (48 h to <1 year of age) with ALTE who received chest compressions for ≥2 min, were comatose, and required mechanical ventilation after return of circulation were included. Infants were randomised to therapeutic hypothermia (33 °C) (n = 26) or therapeutic normothermia (36.8 °C) (n = 28) within six hours of return of circulation. Outcomes included 12-month survival with Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score ≥70, 12-month survival, change in VABS-II score from pre-arrest to 12 months post-arrest, and select safety measures. Results Amongst infants with pre-arrest VABS-II ≥70 (n = 52), there was no difference in 12-month survival with VABS-II ≥70 between therapeutic hypothermia and therapeutic normothermia groups (2/25 (8.0%) vs. 1/27 (3.7%); relative risk 2.16; 95% confidence interval 0.21–22.38, p = 0.60). Amongst all evaluable infants (n = 53), the change in VABS-II score from pre-arrest to 12 months post-arrest did not differ (p = 0.078) between therapeutic hypothermia and therapeutic normothermia groups, nor did 12-month survival (5/26 (19.2%) vs. 1/27 (3.7%); relative risk 5.19; 95% confidence interval 0.65–41.50, p = 0.10). Conclusions Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644)

LanguageEnglish (US)
Pages40-48
Number of pages9
JournalResuscitation
Volume109
DOIs
StatePublished - Dec 1 2016

Fingerprint

Out-of-Hospital Cardiac Arrest
Safety
Temperature
Induced Hypothermia
Psychological Adaptation
Survival
Therapeutics
Coma
Confidence Intervals
Artificial Respiration
Survivors
Thorax
Pediatrics
Mortality

Keywords

  • Apparent life threatening event
  • Cardiac arrest
  • Functional outcome
  • Mortality
  • Sudden infant death syndrome
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events. / Meert, Kathleen; Telford, Russell; Holubkov, Richard; Slomine, Beth S.; Christensen, James R.; Dean, J. Michael; Moler, Frank W.

In: Resuscitation, Vol. 109, 01.12.2016, p. 40-48.

Research output: Research - peer-reviewArticle

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N2 - Objective To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. Methods Fifty-four infants (48 h to <1 year of age) with ALTE who received chest compressions for ≥2 min, were comatose, and required mechanical ventilation after return of circulation were included. Infants were randomised to therapeutic hypothermia (33 °C) (n = 26) or therapeutic normothermia (36.8 °C) (n = 28) within six hours of return of circulation. Outcomes included 12-month survival with Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score ≥70, 12-month survival, change in VABS-II score from pre-arrest to 12 months post-arrest, and select safety measures. Results Amongst infants with pre-arrest VABS-II ≥70 (n = 52), there was no difference in 12-month survival with VABS-II ≥70 between therapeutic hypothermia and therapeutic normothermia groups (2/25 (8.0%) vs. 1/27 (3.7%); relative risk 2.16; 95% confidence interval 0.21–22.38, p = 0.60). Amongst all evaluable infants (n = 53), the change in VABS-II score from pre-arrest to 12 months post-arrest did not differ (p = 0.078) between therapeutic hypothermia and therapeutic normothermia groups, nor did 12-month survival (5/26 (19.2%) vs. 1/27 (3.7%); relative risk 5.19; 95% confidence interval 0.65–41.50, p = 0.10). Conclusions Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644)

AB - Objective To explore the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to an apparent life threatening event (ALTE) recruited to the Therapeutic Hypothermia after Paediatric Cardiac Arrest Out-of-Hospital trial. Methods Fifty-four infants (48 h to <1 year of age) with ALTE who received chest compressions for ≥2 min, were comatose, and required mechanical ventilation after return of circulation were included. Infants were randomised to therapeutic hypothermia (33 °C) (n = 26) or therapeutic normothermia (36.8 °C) (n = 28) within six hours of return of circulation. Outcomes included 12-month survival with Vineland Adaptive Behaviour Scales, Second Edition (VABS-II) score ≥70, 12-month survival, change in VABS-II score from pre-arrest to 12 months post-arrest, and select safety measures. Results Amongst infants with pre-arrest VABS-II ≥70 (n = 52), there was no difference in 12-month survival with VABS-II ≥70 between therapeutic hypothermia and therapeutic normothermia groups (2/25 (8.0%) vs. 1/27 (3.7%); relative risk 2.16; 95% confidence interval 0.21–22.38, p = 0.60). Amongst all evaluable infants (n = 53), the change in VABS-II score from pre-arrest to 12 months post-arrest did not differ (p = 0.078) between therapeutic hypothermia and therapeutic normothermia groups, nor did 12-month survival (5/26 (19.2%) vs. 1/27 (3.7%); relative risk 5.19; 95% confidence interval 0.65–41.50, p = 0.10). Conclusions Mortality was high amongst infants that were comatose after out-of-hospital cardiac arrest due to ALTE in both therapeutic hypothermia and therapeutic normothermia treated groups. Functional status was markedly reduced among survivors. (ClinicalTrials.gov, NCT00878644)

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KW - Sudden infant death syndrome

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