Moler Frank W, Hutchison Jamie S, Nadkarni Vinay M, Silverstein Faye S, Meert Kathleen L, Holubkov Richard, Page Kent, Slomine Beth S, Christensen James R, Dean J Michael
1Department of Pediatrics, University of Michigan, Ann Arbor, MI. 2Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 3Pediatric Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA. 4Department of Pediatrics, Wayne State University, Detroit, MI. 5Department of Pediatrics, University of Utah, Salt Lake City, UT. 6Department of Physical Medicine and Rehabilitation and Neuropsychology, Kennedy Krieger Institute and Johns Hopkins University, Baltimore, MD.
Pediatr Crit Care Med. 2016 Aug;17(8):712-20. doi: 10.1097/PCC.0000000000000763.
To describe outcomes and complications in the drowning subgroup from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital trial.
Exploratory post hoc cohort analysis.
Twenty-four PICUs.
Pediatric drowning cases.
Therapeutic hypothermia versus therapeutic normothermia.
An exploratory study of pediatric drowning from the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital trial was conducted. Comatose patients aged more than 2 days and less than 18 years were randomized up to 6 hours following return-of-circulation to hypothermia (n = 46) or normothermia (n = 28). Outcomes assessed included 12-month survival with a Vineland Adaptive Behavior Scale score of greater than or equal to 70, 1-year survival rate, change in Vineland Adaptive Behavior Scale-II score from prearrest to 12 months, and select safety measures. Seventy-four drowning cases were randomized. In patients with prearrest Vineland Adaptive Behavior Scale-II greater than or equal to 70 (n = 65), there was no difference in 12-month survival with Vineland Adaptive Behavior Scale-II score of greater than or equal to 70 between hypothermia and normothermia groups (29% vs 17%; relative risk, 1.74; 95% CI, 0.61-4.95; p = 0.27). Among all evaluable patients (n = 68), the Vineland Adaptive Behavior Scale-II score change from baseline to 12 months did not differ (p = 0.46), and 1-year survival was similar (49% hypothermia vs 42%, normothermia; relative risk, 1.16; 95% CI, 0.68-1.99; p = 0.58). Hypothermia was associated with a higher prevalence of positive bacterial culture (any blood, urine, or respiratory sample; 67% vs 43%; p = 0.04); however, the rate per 100 days at risk did not differ (11.1 vs 8.4; p = 0.46). Cumulative incidence of blood product use, serious arrhythmias, and 28-day mortality were not different. Among patients with cardiopulmonary resuscitation durations more than 30 minutes or epinephrine doses greater than 4, none had favorable Pediatric Cerebral Performance Category outcomes (≤ 3).
In comatose survivors of out-of-hospital pediatric cardiac arrest due to drowning, hypothermia did not result in a statistically significant benefit in survival with good functional outcome or mortality at 1 year, as compared with normothermia. High risk of culture-proven bacterial infection was observed in both groups.
描述院外小儿心脏骤停后治疗性低温试验中溺水亚组的结局和并发症。
探索性事后队列分析。
24个儿科重症监护病房。
小儿溺水病例。
治疗性低温与治疗性正常体温。
对院外小儿心脏骤停后治疗性低温试验中的小儿溺水进行了一项探索性研究。年龄超过2天且小于18岁的昏迷患者在恢复循环后长达6小时被随机分为低温治疗组（n = 46）或正常体温治疗组（n = 28）。评估的结局包括12个月生存率（文兰适应性行为量表得分大于或等于70）、1年生存率、文兰适应性行为量表-II得分从心脏骤停前到12个月的变化以及选定的安全措施。74例溺水病例被随机分组。在心脏骤停前文兰适应性行为量表-II得分大于或等于70的患者（n = 65）中，低温治疗组和正常体温治疗组12个月生存率（文兰适应性行为量表-II得分大于或等于70）无差异（29%对17%；相对风险，1.74；95%CI，0.61 - 4.95；p = 0.27）。在所有可评估患者（n = 68）中，文兰适应性行为量表-II得分从基线到12个月的变化无差异（p = 0.46），1年生存率相似（低温治疗组49%对正常体温治疗组42%；相对风险，1.16；95%CI，0.68 - 1.99；p = 0.58）。低温治疗与阳性细菌培养的患病率较高相关（任何血液、尿液或呼吸道样本；67%对43%；p = 0.04）；然而，每100天的风险发生率无差异（11.1对8.4；p = 0.46）。血液制品使用、严重心律失常和28天死亡率的累积发生率无差异。在心肺复苏持续时间超过30分钟或肾上腺素剂量大于4的患者中，无一例有良好的小儿脑功能分类结局（≤3）。
与正常体温相比，对于因溺水导致院外小儿心脏骤停的昏迷幸存者，低温治疗在1年时并未在良好功能结局的生存率或死亡率方面产生统计学上的显著益处。两组均观察到经培养证实的细菌感染高风险。
