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

for the THAPCA Trial Investigators

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)88-97
Number of pages10
JournalResuscitation
Volume135
DOIs
StatePublished - Feb 1 2019

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Out-of-Hospital Cardiac Arrest
Pediatric Hospitals
Hypothermia
Temperature
Survival
Logistic Models
Induced Hypothermia
Psychological Adaptation
Pediatrics

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine

Cite this

Pediatric out-of-hospital cardiac arrest : Time to goal target temperature and outcomes. / for the THAPCA Trial Investigators.

In: Resuscitation, Vol. 135, 01.02.2019, p. 88-97.

Research output: Contribution to journalArticle

for the THAPCA Trial Investigators. / Pediatric out-of-hospital cardiac arrest : Time to goal target temperature and outcomes. In: Resuscitation. 2019 ; Vol. 135. pp. 88-97.
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title = "Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes",
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.",
author = "{for the THAPCA Trial Investigators} and Moler, {Frank W.} and Silverstein, {Faye S.} and Nadkarni, {Vinay M.} and Meert, {Kathleen L.} and Shah, {Samir H.} and Slomine, {Beth S} and Christensen, {James R} and Richard Holubkov and Kent Page and Dean, {J. Michael}",
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T2 - Time to goal target temperature and outcomes

AU - for the THAPCA Trial Investigators

AU - Moler, Frank W.

AU - Silverstein, Faye S.

AU - Nadkarni, Vinay M.

AU - Meert, Kathleen L.

AU - Shah, Samir H.

AU - Slomine, Beth S

AU - Christensen, James R

AU - Holubkov, Richard

AU - Page, Kent

AU - Dean, J. Michael

PY - 2019/2/1

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N2 - 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.

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