Multi-center Study Shows No Significant Benefit to Therapeutic Hypothermia in Children who Suffered Out-of-Hospital Cardiac Arrest

Diamond Children’s Medical Center at Banner – University Medical Center Tucson was one of 38 children’sAndreas Theodorou, MD hospitals in the United States and Canada to participate in a large-scale study that has shown no significant difference in outcomes for children who received therapeutic hypothermia and children who maintained a normal body temperature after suffering cardiac arrest.

Cardiac arrest in children can often be a catastrophic event, resulting in brain injury, other long-term neurological disabilities or even death.

Therapeutic hypothermia can improve survival and health outcomes for adults after cardiac arrest and also for newborns with brain injury due to a lack of oxygen at birth. But, until now, this treatment has not been studied in infants or children admitted to hospitals with cardiac arrest.

The results were published in the April 25, 2015, edition of the New England Journal of Medicine.

Katri Typpo, MD, MPHAt Diamond Children’s, the study was led by University of Arizona Steele Children’s Research Center pediatric intensivists Andreas Theodorou, MD, professor, UA Department of Pediatrics and chief medical officer  of Banner – University Medical Center Tucson, and Katri Typpo, MD, MPH, assistant professor, UA Department of Pediatrics. Co-investigators on the study were Chad Viscusi, MD, assistant professor, UA Department of Emergency Medicine, and Janet Teodori, MD, clinical assistant professor, UA Department of Pediatrics and UA Department of Neurology.

“We were honored to participate in this very important study and to work with our colleagues in the United States and Canada,” said Dr. Theodorou.

More than 6,000 children suffer out-of-hospital cardiac arrest in the United States each year, according to the American Heart Association's 2015 heart disease and stroke statistics.

Janet Teodori, MDThe 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 randomly were 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 circulated 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.

One year after treatment, researchers observed no difference in survival or cognitive function between the groups.

Chad Viscusi, MD“This study has helped us clarify how to care for children after they sustained cardiac arrest,” explained Dr. Theodorou. “It also highlights how one cannot automatically take results from studies on adults and apply them to infants and children.”

Out-of-hospital cardiac arrest in infants and children typically results from causes such as strangulation, drowning or trauma. 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 to prevent fever, which commonly occurs after cardiac arrest and can lead to more severe outcomes.

“I would like to recognize, with respect and gratitude, the families that agreed to participate in this study, during what was likely the most difficult and stressful time of their lives,” said Dr. Theodorou.  “I consider them heroes for thinking about others in their time of personal challenge.”

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 trials are funded through the National Heart, Lung, and Blood Institute (NHLBI).

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.

The UA Steele Children’s Research Center is one of the prestigious Centers of Excellence within the UA College of Medicine at the Arizona Health Sciences Center. It is the only facility in Southern Arizona where researchers and physician-scientists are dedicated to advancing medical knowledge through research to improve children’s health. As researchers, they seek to discover answers to children’s medical mysteries. As physician-scientists, they provide compassionate care to hospitalized patients at Diamond Children’s Medical Center and pediatric outpatient clinics throughout Tucson and the state. And, as faculty members with the UA Department of Pediatrics, they teach and train the next generation of pediatricians and researchers.

About Banner – University Medical Center Tucson and South
Banner – University Medical Center Tucson and Banner – University Medical Center South are part of Banner – University Medicine, a premier academic medical network. These institutions are academic medical centers for the University of Arizona College of Medicine – Tucson. Included on the two campuses are Diamond Children's Medical Center and many clinics. The two academic medical centers are part of Arizona-based Banner Health, one of the largest nonprofit health-care systems in the country. Banner Health operates  in seven states: Alaska, Arizona, California, Colorado, Nebraska, Nevada and Wyoming. For more information, please visit www.BannerHealth.com/UniversityTucson or www.bannerhealth.com/UniversitySouth