Effectiveness of Two Targeted Temperature Management Methods After Pediatric Postcardiac Arrest
| Autor: | J. Cordero, Carlos Acuña, Maria Elisa Nalegach, Jorge Roque, Pablo Cruces, Roberto Dalmazzo, Adriana Wegner, Mauricio Yunge, Lilian Hickmann, Antonio Morales, Fernando Mallea, Florencia Jerez, Magdalena Castro, Pablo Oyaguez, Daniela Martinez, Betsy Diaz, Corrado Cecchetti, Michelangelo Lapadula, Pablo Bravo, Michele Drago, Gonzalo Morales, Leticia J. Yañez, Amanda Menchaca, Raul Bustos, Manuel Nieto, Alicia Miras, Jesús López-Herce, Lorena Arrau, Yolanda Lopez, Maritza Glasinovic, German Sepulveda |
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| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Adolescent medicine.medical_treatment 030204 cardiovascular system & hematology Return of spontaneous circulation Targeted temperature management Intensive Care Units Pediatric Critical Care and Intensive Care Medicine Article Body Temperature 03 medical and health sciences 0302 clinical medicine Primary outcome Clinical Protocols Hypothermia Induced medicine Humans Prospective Studies Rewarming Child Prospective cohort study Mechanical ventilation Coma business.industry Infant 030208 emergency & critical care medicine South America Hypothermia Cardiopulmonary Resuscitation Heart Arrest Europe Clinical trial Child Preschool Pediatrics Perinatology and Child Health Emergency medicine Female medicine.symptom business |
| Zdroj: | Pediatric Critical Care Medicine. 20:e77-e82 |
| ISSN: | 1529-7535 |
| DOI: | 10.1097/pcc.0000000000001813 |
| Popis: | OBJECTIVES It is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children. DESIGN Prospective, multicenter, nonrandomized, study. SETTING PICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014. PATIENTS Under 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included. METHODS TTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months. PRIMARY OUTCOME feasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months. MEASUREMENTS AND MAIN RESULTS Seventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups. CONCLUSIONS TTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques. |
| Databáze: | OpenAIRE |
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