Association of Temperature Management Strategy with Fever in Critically Ill Children After Out-of-hospital Cardiac Arrest

Overview

Journal Front Pediatr

Specialty Pediatrics

Date 2024 Apr 25

PMID 38659696

Authors

Micah Kadden

Anqing Zhang

Michael Shoykhet

Affiliations

Soon will be listed here.

Abstract

Objective: To determine whether ICU temperature management strategy is associated with fever in children with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA).

Methods: We conducted a single-center retrospective cohort study at a quaternary Children's hospital between 1/1/2016-31/12/2020. Mechanically ventilated children (<18 y/o) admitted to Pediatric or Cardiac ICU (PICU/CICU) with ROSC after OHCA who survived at least 72 h were included. Primary exposure was initial PICU/CICU temperature management strategy of: (1) passive management; or (2) warming with an air-warming blanket; or (3) targeted temperature management with a heating/cooling (homeothermic) blanket. Primary outcome was fever (≥38°C) within 72 h of admission.

Results: Over the study period, 111 children with ROSC after OHCA were admitted to PICU/CICU, received mechanical ventilation and survived at least 72 h. Median age was 31 (IQR 6-135) months, 64% (71/111) were male, and 49% (54/111) were previously healthy. Fever within 72 h of admission occurred in 51% (57/111) of patients. The choice of initial temperature management strategy was associated with occurrence of fever ( = 9.36, df = 2, = 0.009). Fever occurred in 60% (43/72) of patients managed passively, 45% (13/29) of patients managed with the air-warming blanket and 10% (1/10) of patients managed with the homeothermic blanket. Compared to passive management, use of homeothermic, but not of air-warming, blanket reduced fever risk [homeothermic: Risk Ratio (RR) = 0.17, 95%CI 0.03-0.69; air-warming: RR = 0.75, 95%CI 0.46-1.12]. To prevent fever in one child using a homeothermic blanket, number needed to treat (NNT) = 2.

Conclusion: In critically ill children with ROSC after OHCA, ICU temperature management strategy is associated with fever. Use of a heating/cooling blanket with homeothermic feedback reduces fever incidence during post-arrest care.

References

Bro-Jeppesen J, Hassager C, Wanscher M, Soholm H, Thomsen J, Lippert F . Post-hypothermia fever is associated with increased mortality after out-of-hospital cardiac arrest. Resuscitation. 2013; 84(12):1734-40. DOI: 10.1016/j.resuscitation.2013.07.023. View

den Hartog A, de Pont A, Robillard L, Binnekade J, Schultz M, Horn J . Spontaneous hypothermia on intensive care unit admission is a predictor of unfavorable neurological outcome in patients after resuscitation: an observational cohort study. Crit Care. 2010; 14(3):R121. PMC: 2911769. DOI: 10.1186/cc9077. View

Moler F, Donaldson A, Meert K, Brilli R, Nadkarni V, Shaffner D . Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med. 2010; 39(1):141-9. PMC: 3297020. DOI: 10.1097/CCM.0b013e3181fa3c17. View

Berg K, Soar J, Andersen L, Bottiger B, Cacciola S, Callaway C . Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation. 2020; 142(16_suppl_1):S92-S139. DOI: 10.1161/CIR.0000000000000893. View

Brown D, Brugger H, Boyd J, Paal P . Accidental hypothermia. N Engl J Med. 2012; 367(20):1930-8. DOI: 10.1056/NEJMra1114208. View

Sterz F, Safar P, TISHERMAN S, Radovsky A, Kuboyama K, Oku K . Mild hypothermic cardiopulmonary resuscitation improves outcome after prolonged cardiac arrest in dogs. Crit Care Med. 1991; 19(3):379-89. DOI: 10.1097/00003246-199103000-00017. View

. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002; 346(8):549-56. DOI: 10.1056/NEJMoa012689. View

Dietrichs E, Tveita T, Smith G . Hypothermia and cardiac electrophysiology: a systematic review of clinical and experimental data. Cardiovasc Res. 2018; 115(3):501-509. DOI: 10.1093/cvr/cvy305. View

Gildea M, Moler F, Page K, Pemberton V, Holubkov R, Nadkarni V . Practice Patterns after the Therapeutic Hypothermia After Pediatric Cardiac Arrest Out-of-Hospital Trial: A Survey of Pediatric Critical Care Physicians. J Pediatr Intensive Care. 2019; 8(2):71-77. PMC: 6517059. DOI: 10.1055/s-0038-1667380. View

10.

Geurts M, Macleod M, Kollmar R, Kremer P, van der Worp H . Therapeutic hypothermia and the risk of infection: a systematic review and meta-analysis. Crit Care Med. 2013; 42(2):231-42. DOI: 10.1097/CCM.0b013e3182a276e8. View

11.

Pollack M, Holubkov R, Funai T, Clark A, Berger J, Meert K . Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med. 2014; 15(9):821-7. PMC: 4221484. DOI: 10.1097/PCC.0000000000000250. View

12.

Watts D, Trask A, Soeken K, Perdue P, Dols S, Kaufmann C . Hypothermic coagulopathy in trauma: effect of varying levels of hypothermia on enzyme speed, platelet function, and fibrinolytic activity. J Trauma. 1998; 44(5):846-54. DOI: 10.1097/00005373-199805000-00017. View

13.

Moler F, Silverstein F, Holubkov R, Slomine B, Christensen J, Nadkarni V . Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med. 2015; 372(20):1898-908. PMC: 4470472. DOI: 10.1056/NEJMoa1411480. View

14.

Hermel M, Bosson N, Fang A, French W, Niemann J, Sung G . Implementation of Targeted Temperature Management After Out-of-Hospital Cardiac Arrest: Observations From the Los Angeles County Regional System. J Am Heart Assoc. 2020; 9(24):e016652. PMC: 7955369. DOI: 10.1161/JAHA.120.016652. View

15.

Bernard S, Gray T, Buist M, Jones B, Silvester W, Gutteridge G . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002; 346(8):557-63. DOI: 10.1056/NEJMoa003289. View

16.

Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C . Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013; 369(23):2197-206. DOI: 10.1056/NEJMoa1310519. View

17.

Pollack M, Holubkov R, Glass P, Dean J, Meert K, Zimmerman J . Functional Status Scale: new pediatric outcome measure. Pediatrics. 2009; 124(1):e18-28. PMC: 3191069. DOI: 10.1542/peds.2008-1987. View

18.

Slomine B, Silverstein F, Christensen J, Holubkov R, Telford R, Dean J . Neurobehavioural outcomes in children after In-Hospital cardiac arrest. Resuscitation. 2018; 124:80-89. PMC: 5837951. DOI: 10.1016/j.resuscitation.2018.01.002. View

19.

Hunfeld M, Nadkarni V, Topjian A, Harpman J, Tibboel D, van Rosmalen J . Timing and Cause of Death in Children Following Return of Circulation After Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Cohort Study. Pediatr Crit Care Med. 2020; 22(1):101-113. DOI: 10.1097/PCC.0000000000002577. View

20.

Young K, Gausche-Hill M, McClung C, Lewis R . A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics. 2004; 114(1):157-64. DOI: 10.1542/peds.114.1.157. View