A Report of Three Cases where Therapeutic Hypothermia was done After the Return of Spontaneous Circulation After Out-of-Hospital Cardiac Arrest in Children and Adolescents

ABSTRACT

Cardiac arrest in infants, children and adolescents is rare but critical; survival from out-of-hospital pediatric cardiac arrest is estimated at 8% to 12%. Mild therapeutic hypothermia was shown to improve the neurologic outcome of postcardiac arrest syndrome in adults and neonatal hypoxic-ischemic encephalopathy, but its use has been limited in children. We report 3 cases where therapeutic hypothermia was successfully done in infants and children. The initial rhythm was ventricular fibrillation of a 13 year old child, asystole in an 11 month old infant, and in 7 aged children. Therapeutic hypothermia was induced and maintained successfully for 24 hours via endovascular and surface cooling methods. The older child with ventricular fibrillation awoke from being comatose after rewarming and cessation of sedatives. The 11 month old and the 7 aged children died during the 16 days following admission and being discharged with a neurologic disability. There is lack of evidence that therapeutic hypothermia improves neurologic outcomes in pediatric cardiac arrest patients, but in adults and in neonatal hypoxicischemic encephalopathy, we can speculate that therapeutic hypothermia in pediatric patients will have a good outcome. A multicenter randomized study is needed as are guidelines and common protocols about pediatric therapeutic hypothermia.