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Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes.

Publication ,  Journal Article
Moler, FW; Silverstein, FS; Nadkarni, VM; Meert, KL; Shah, SH; Slomine, B; Christensen, J; Holubkov, R; Page, K; Dean, JM ...
Published in: Resuscitation
February 2019

AIM: Although recent out-of-hospital cardiac arrest (CA) trials found no benefits of hypothermia versus normothermia targeted temperature management, preclinical models suggest earlier timing of hypothermia improves neuroprotective efficacy. This study investigated whether shorter time to goal temperature was associated with better one-year outcomes in the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial. METHODS: Patients were classified by tertiles of time to attain assigned goal temperature range (32-34°C or 36-37.5°C) following ROSC. Outcomes in the first tertile ("earlier") Group 1 were compared with second and third tertiles ("later") Group 2. Separate analyses were, additionally, completed for hypothermia and normothermia intervention groups. Three one-year outcomes were examined: survival; Vineland Adaptive Behavior Scale (VABS-II) score≥70; and decrease in VABS-II≤15 points from baseline. RESULTS: In the entire cohort (n=281), median time from ROSC to goal temperature was 7.4 [IQR 6.2-9.7] hours: Group 1, 5.8 [IQR 5.2, 6.2] and Group 2, 8.8 [IQR 7.4, 10.4] h. Outcomes did not differ between these groups. For hypothermia subgroup, survival was lower in Group 1 than 2, [10/49(20%) versus 47/99(47%), p<0.002], with a trend toward fewer with VABS-II scores≥70 and change in VABS-II≤15 points (p=0.07-0.08). For normothermia subgroup, there was a trend toward higher survival in Group 1 than 2 [18/42(43%) versus 21/83(25%), p=0.065], but no differences in VABS-II-related measures. In multivariable logistic regression models, no difference in earlier and later groups or temperature intervention was observed. CONCLUSION: We found no evidence that earlier time to goal temperature was associated with better outcomes.

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Published In

Resuscitation

DOI

EISSN

1873-1570

Publication Date

February 2019

Volume

135

Start / End Page

88 / 97

Location

Ireland

Related Subject Headings

  • Time-to-Treatment
  • Survival Analysis
  • Patient Care Planning
  • Outcome Assessment, Health Care
  • Out-of-Hospital Cardiac Arrest
  • Neuropsychological Tests
  • Neuroprotection
  • Male
  • Infant
  • Hypothermia, Induced
 

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Moler, F. W., Silverstein, F. S., Nadkarni, V. M., Meert, K. L., Shah, S. H., Slomine, B., … THAPCA Trial Investigators, . (2019). Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation, 135, 88–97. https://doi.org/10.1016/j.resuscitation.2018.12.012
Moler, Frank W., Faye S. Silverstein, Vinay M. Nadkarni, Kathleen L. Meert, Samir H. Shah, Beth Slomine, James Christensen, et al. “Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes.Resuscitation 135 (February 2019): 88–97. https://doi.org/10.1016/j.resuscitation.2018.12.012.
Moler FW, Silverstein FS, Nadkarni VM, Meert KL, Shah SH, Slomine B, et al. Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation. 2019 Feb;135:88–97.
Moler, Frank W., et al. “Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes.Resuscitation, vol. 135, Feb. 2019, pp. 88–97. Pubmed, doi:10.1016/j.resuscitation.2018.12.012.
Moler FW, Silverstein FS, Nadkarni VM, Meert KL, Shah SH, Slomine B, Christensen J, Holubkov R, Page K, Dean JM, THAPCA Trial Investigators. Pediatric out-of-hospital cardiac arrest: Time to goal target temperature and outcomes. Resuscitation. 2019 Feb;135:88–97.
Journal cover image

Published In

Resuscitation

DOI

EISSN

1873-1570

Publication Date

February 2019

Volume

135

Start / End Page

88 / 97

Location

Ireland

Related Subject Headings

  • Time-to-Treatment
  • Survival Analysis
  • Patient Care Planning
  • Outcome Assessment, Health Care
  • Out-of-Hospital Cardiac Arrest
  • Neuropsychological Tests
  • Neuroprotection
  • Male
  • Infant
  • Hypothermia, Induced