Therapeutic hypothermia is recommended for comatose adults after witnessed out-of-hospital cardiac arrest, but there have been recent questions about its effectiveness and data about this intervention in children are limited. Moler et al recruited children older than two days and younger than 18 years of age who remained unconscious after having an out-of-hospital cardiac arrest with return of spontaneous circulation. The authors then randomized these patients into either a therapeutic hypothermia arm or a therapeutic normothermia arm. The primary outcome was survival at 12 months with a good neurobehavioral outcome.
In comatose children who survived out-of-hospital cardiac arrest, therapeutic hypothermia, as compared with therapeutic normothermia, did not confer a significant benefit in survival with a good functional outcome at one year.
With this study’s findings, a general lack of clarity about the efficacy of therapeutic hypothermia in general has materialized. Previously, Nielsen et al described the lack of benefit in mortality or neurologic outcomes in adult cardiac arrest patients who underwent therapeutic hypothermia compared to those patients in the therapeutic normothermia arm. Further studies will be needed to definitively judge this therapy’s overall usefulness in both the adult and pediatric population.
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