Exploring the safety and efficacy of targeted temperature management amongst infants with out-of-hospital cardiac arrest due to apparent life threatening events. (December 2016)

• Record Type: Journal Article
• Authors: Meert, Kathleen; Telford, Russell; Holubkov, Richard; Slomine, Beth S.; Christensen, James R.; Dean, J. Michael; Moler, Frank W.
• Is Part Of: Resuscitation. Volume 109(2016)
• Page Start: 40
• Page End: 48
• Publication Date: 2016-12
• Subjects: Sudden infant death syndrome -- Apparent life threatening event -- Cardiac arrest -- Therapeutic hypothermia -- Mortality -- Functional outcome; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2016.09.026
• Languages: English
• ISSNs: 0300-9572

Abstract

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)