24 vs. 72 hours of hypothermia for pediatric cardiac arrest: A pilot, randomized controlled trial

RESUSCITATION

卷:126

Article

Fink, Ericka L.^1,4,9,10  Clark, Robert S. B.^1,4,9  Berger, Rachel P.^2,9  Fabio, Anthony³  Angus, Derek C.^4,10  Watson, R. Scott^5,6  Gianakas, John J.³  Panigrahy, Ashok⁷  Callaway, Clifton W.^8,9  Bell, Michael J.¹¹  Kochanek, Patrick M.^1,4,9 

[1] UPMC, Childrens Hosp Pittsburgh, Crit Care Med, Pittsburgh, PA USA

[2] UPMC, Childrens Hosp Pittsburgh, Pediat, Pittsburgh, PA USA

[3] Univ Pittsburgh, Sch Med, Dept Epidemiol, Pittsburgh, PA USA

[4] Univ Pittsburgh, Med Ctr, Crit Care Med, Pittsburgh, PA USA

[5] Univ Washington, Sch Med, Dept Pediat, Seattle, WA 98195 USA

[6] Seattle Childrens Res Inst, Ctr Child Hlth Behav & Dev, Seattle, WA USA

[7] UPMC, Childrens Hosp Pittsburgh, Radiol, Pittsburgh, PA USA

[8] Univ Pittsburgh, Med Ctr, Emergency Med, Pittsburgh, PA USA

[9] Safar Ctr Resuscitat Res, Pittsburgh, PA USA

[10] Clin Res Invest & Syst Modeling Acute Illness CRI, Pittsburgh, PA USA

[11] Childrens Natl Med Ctr, Pediat, Washington, DC 20010 USA

关键词: Critical care;    Neurologic disorders;    Pediatric;    Cardiac arrest;    Biomarker;    Outcome;   

DOI  :  10.1016/j.resuscitation.2018.02.008

来源: Elsevier

【 摘 要 】

Aim: Children surviving cardiac arrest (CA) lack proven neuroprotective therapies. The role of biomarkers in assessing response to interventions is unknown. We hypothesized that 72 versus 24 h of hypothermia (HT) would produce more favorable biomarker profiles after pediatric CA. Methods: This single center pilot randomized trial tested HT (33 +/- 1 degrees C) for 24 vs. 72 h in 34 children with CA. Children comatose after return of circulation aged 1 week to 17 years and treated with HT by their physician were eligible. Serum was collected twice daily on days 1-4 and once on day 7. Mortality was assessed at 6 months. Results: Patient characteristics, baseline biomarker concentrations, and adverse events were similar between groups. Eight (47%) and 4 (24%) children died in the 24 h and 72 h groups, p = .3. Serum neuron specific enolase (NSE) concentration was increased in the 24 vs. 72 h group at 84 h-96 h (median [interquartile range] 47.7 [3.9, 79.9] vs. 1.4 [0.0, 11.1] ng/ml, p = .02) and on day 7 (18.2 [3.2, 74.0] vs. 2.6 [0.0, 12.8] ng/ml, p =. 047). Serum S100b was increased in the 24 h vs. 72 h group at 12 h-24 h, 36 h-84 h, and on day 7, all p < 0.05. HT duration was associated with S100b (but not NSE or MBP) concentration on day 7 in multivariate analyses. Conclusion: Serum biomarkers show promise as theragnostic tools in pediatric CA. Our biomarker and safety data also suggest that 72 h duration after pediatric CA warrants additional exploration.

【 授权许可】

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