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Study Results Could Change the Standard of Care for Children after Cardiac Arrest

John Berger

While whole body cooling reduces brain or organ damage in adults following cardiac arrest, researchers from Children’s National Health System and other academic institutions found it does not show marked improvement over maintaining body temperature within a normal range for children who had cardiac arrest.

The six-year effort, one of the largest and most complex cardiac studies of its kind, shows that either treatment plan can be effective, said John T. Berger, III, MD, Medical Director, Cardiac Intensive Care, Director of Pulmonary Hypertension Program, Divisions of Critical Care Medicine and Cardiology, and site Principal Investigator for the study. The findings were published in The New England Journal of Medicine

The study opens the door for evidence-based guidelines that would improve the quality of pediatric care and outcomes for children who had cardiac arrests, Dr. Berger said. 

For comatose adults who suffered a cardiac arrest, the standard of care is to implement therapeutic hypothermia, which is cooling the body to 89 degrees, and the practice reduces brain and organ damage.  Until now, this treatment had not been studied in infants or comatose children admitted to the hospital with cardiac arrest.

The latest study showed that it does not improve survival or cognitive function in children  after one year of follow up, any better than maintaining body temperature within normal range, such as orally at 98.6 degrees Fahrenheit. A goal of each procedure is to prevent fever, which commonly occurs after cardiac arrest and can lead to more severe outcomes, such as worsened brain injury.

Now that the study has found each treatment – body cooling and controlling normal temperature -- is equally effective, the results “provide evidence for guidelines for temperature control in children. No such guidelines currently exist,” Dr. Berger said. “The clear impact of the study is that strict standardization of care and management of temperature is necessary after children have a cardiac arrest.” 

More than 6,000 children suffer out-of-hospital cardiac arrest in the U.S. each year, according to the American Heart Association’s 2015 heart and stroke statistics. Unlike adults, whose cardiac arrests are based on deterioration of the heart, children’s cardiac arrests often are related to breathing and lung problems, Dr. Berger said.

The study is part of the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials. 

A second study is underway focusing on hospital inpatients. The trials involve at least 38 healthcare and academic institutions. Children’s National was a leading clinically enrolling site for the THAPCA trials.

The research findings were presented at the Pediatric Academic Societies Annual Meeting in San Diego. The THAPCA trials are conducted in partnership with the National Heart, Lung and Blood Institute (NHLBI) , the Collaborative Pediatric Critical Care Research Network of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the Pediatric Emergency Care Applied Research Network under the Health Resources and Service Administration’s maternal and child health bureau. 

The study was funded by the National Heart, Lung and Blood Institute (NHLBI) of the National Institutes of Health. 

Contact: Emily Hartman at 202-476-4500.


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