Controlled therapeutic hypothermia after cardiac arrest may improve survival and outcomes for adults, but is the same true for infants, children and adolescents? The CHOC Children’s Pediatric Intensive Care Unit is one of 33 in the nation participating in the NIH-funded Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) study investigating the potential benefits.
“There are significant differences between the pediatric and adult populations,” said pediatric intensivist Adam Schwarz, M.D., who is leading the study at CHOC. “First, the causes of cardiac arrest in children are usually quite different than for adults. About 90 percent of pediatric cardiac arrests are secondary to asphyxiation or hypoxia. Additionally, control groups in the adult studies showed a high incidence of fever.” The THAPCA study seeks to answer whether one strictly controlled temperature or another, after resuscitation from cardiac arrest, lead to significant survival outcomes. Half of the participants are randomized to being placed onto temperature-controlled blankets and cooled to 32°C – 34°C for 48 hours, then slowly re-warmed back to 37°C and maintained at normal body temperature for three more days until five days of study are completed. The control group keeps body temperature at 37°C for all five days. Cooling is not without potential risks. Dr. Schwarz said a study involving children who were cooled following traumatic brain injuries showed worse outcomes than those in the control group. “Controlled hypothermia after pediatric cardiac arrest is absolutely not a proven therapy in our patient population and shouldn’t be done outside a strictly controlled study until such results are known,” Dr. Schwarz said. CHOC went live with the THAPCA study in April 2011, and three patients have been enrolled. Nationwide, more than 250 infants, children and adolescents are currently enrolled with a target of 800. For more information about research at CHOC, please visit www.choc.org.