Department of Cardiology, Boston Children's Hospital, United States.
Department of Pediatrics, University of California, San Francisco, United States.
Resuscitation. 2018 May;126:83-89. doi: 10.1016/j.resuscitation.2018.02.022. Epub 2018 Feb 21.
While therapeutic hypothermia (TH) is an effective neuroprotective therapy for neonatal hypoxic-ischemic encephalopathy, TH has not been demonstrated to improve outcome in other pediatric populations. Patients with acquired or congenital heart disease (CHD) are at high risk of both cardiac arrest and neurodevelopmental impairments, and therapies are needed to improve neurologic outcome. The primary goal of our study was to compare safety/efficacy outcomes in post-arrest CHD patients treated with TH versus controls not treated with TH.
Patients with CHD treated during the first 18 months after initiation of a post-arrest TH protocol (temperature goal: 33.5 °C) were compared to historical and contemporary post-arrest controls not treated with TH. Post-arrest data, including temperature, safety measures (e.g. arrhythmia, bleeding), neurodiagnostic data (EEG, neuroimaging), and survival were compared.
Thirty arrest episodes treated with TH and 51 control arrest episodes were included. The groups did not differ in age, duration of arrest, post-arrest lactate, or use of ECMO-CPR. The TH group's post-arrest temperature was significantly lower than control's (33.6 ± 0.2 °C vs 34.7 ± 0.5 °C, p < 0.001). There was no difference between the groups in safety/efficacy measures, including arrhythmia, infections, chest-tube output, or neuroimaging abnormalities, nor in hospital survival (TH 61.5% vs control 59.1%, p = NS). Significantly more controls had seizures than TH patients (26.1% vs. 4.0%, p = 0.04). Almost all seizures were subclinical and occurred more than 24 h post-arrest.
Our data show that pediatric CHD patients who suffer cardiac arrest can be treated effectively and safely with TH, which may decrease the incidence of seizures.
虽然治疗性低温（TH）是治疗新生儿缺氧缺血性脑病的有效神经保护疗法，但在其他儿科人群中，TH 并未显示出改善预后的作用。患有获得性或先天性心脏病（CHD）的患者既有心脏骤停的风险，也有神经发育障碍的风险，因此需要治疗方法来改善神经预后。我们研究的主要目标是比较接受 TH 治疗的心脏骤停后 CHD 患者与未接受 TH 治疗的对照组的安全性/疗效结果。
将接受心脏骤停后 TH 治疗方案（目标温度：33.5°C）治疗的 CHD 患者与未接受 TH 治疗的历史和当代心脏骤停后对照组进行比较。比较了心脏骤停后的数据，包括体温、安全性措施（如心律失常、出血）、神经诊断数据（EEG、神经影像学）和存活率。
30 例接受 TH 治疗的心脏骤停发作和 51 例接受对照治疗的心脏骤停发作被纳入研究。两组在年龄、心脏骤停持续时间、心脏骤停后血乳酸水平或 ECMO-CPR 的使用方面没有差异。TH 组的心脏骤停后体温明显低于对照组（33.6±0.2°C 与 34.7±0.5°C，p<0.001）。两组在安全性/疗效指标方面无差异，包括心律失常、感染、胸管引流量或神经影像学异常，也无住院存活率（TH 组为 61.5%，对照组为 59.1%，p=NS）。对照组的癫痫发作发生率明显高于 TH 组（26.1%比 4.0%，p=0.04）。几乎所有的癫痫发作都是亚临床的，发生在心脏骤停后 24 小时以上。
我们的数据表明，患有心脏骤停的小儿 CHD 患者可以接受 TH 治疗，并且可以安全有效地治疗，这可能会降低癫痫发作的发生率。
