Kennedy Krieger Researchers Help Discover Hypothermia May Not Be Best Treatment for Cardiac Arrest in Children
BALTIMORE, MD – A Kennedy Krieger Institute team is part of a large-scale, multicenter research study that has shown therapeutic hypothermia, or whole body cooling, does not improve survival rates or mitigate brain injury in infants and children after out-of-hospital cardiac arrest.
This emergency body cooling is known to improve survival and outcomes for adults after cardiac arrest and also for newborns deprived of oxygen at birth, but had not previously been studied in infants or children. The research findings were presented at the Pediatric Academic Societies Annual Meeting in San Diego in April and published simultaneously in the New England Journal of Medicine.
More than 6,000 U.S. children sustain out-of-hospital cardiac arrest each year, when the heart stops pumping effectively, and blood stops flowing to the brain and other vital organs. The cause in children is often trauma such as accidental drowning or strangulation, and in many cases, the outcome is death or long-term disability.
The study included 295 participants between 2 days and 18 years old who were admitted to children's hospitals for cardiac arrest, required chest compressions for at least two minutes and remained dependent on mechanical ventilation to breathe.
After their parents or guardians provided consent, children were randomly assigned to one of the two treatment groups. One group received body cooling for two days followed by three days of normal temperature control. Another group received normal temperature control for five days.
During the treatment, study participants lay between special blankets. Pumps circulate water through tubes in the blankets to maintain specific body temperature ranges: either a lower range of 89.6-93.2 degrees Fahrenheit or a normal range of 96.8-99.5 degrees Fahrenheit.
The Kennedy Krieger team, led by brain injury rehabilitation experts Drs. James Christensen and Beth Slomine, developed the testing protocol to evaluate the children’s outcomes at both three months and one year after treatment to understand the impact of body cooling on brain function. At the one-year mark, researchers observed no difference in survival or functional outcome between groups.
“Most studies that explore the effectiveness of intensive care interventions for life-threatening illnesses or injuries use survival as the primary outcome measure, but this study is unique in that the we collected detailed information on functional outcome in those who survived,” said Beth Slomine, Ph.D., study co-author and associate director of the Brain Injury Clinical Research Center at Kennedy Krieger Institute. “In doing so, we were gauging quality-of-life for these children, as the goal of any emergency medical treatment is not only to save a life, but also to protect the individual’s functional abilities.”
A separate study by the same researchers is examining body cooling in hospitalized patients who suffer cardiac arrest, typically as a complication of a medical condition. A goal of both studies is preventing fever, which commonly occurs after cardiac arrest and can lead to more severe outcomes.
The study was funded by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health through NHLBI cooperative agreements U01-HL-094339 and U01-HL-094345.
The studies are part of the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials, a six-year effort that is the largest examination of therapeutic hypothermia in children other than newborns for any health condition to date. The THAPCA trials are conducted in partnership with the Collaborative Pediatric Critical Care Research Network, established in 2004 by the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Pediatric Emergency Care Applied Research Network, established in 2001 by the Health Resources and Services Administration's Maternal and Child Health Bureau.
About the Kennedy Krieger Institute
Internationally recognized for improving the lives of children and adolescents with disorders and injuries of the brain, spinal cord and musculoskeletal system, the Kennedy Krieger Institute in Baltimore, MD, serves more than 20,000 individuals each year through inpatient and outpatient clinics, home and community services and school-based programs. Kennedy Krieger provides a wide range of services for children with developmental concerns mild to severe, and is home to a team of investigators who are contributing to the understanding of how disorders develop while pioneering new interventions and earlier diagnosis. For more information on the Kennedy Krieger Institute, visit www.kennedykrieger.org.
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