Lowering Body Temperature After Cardiac Arrest – Discovery and Innovation at University of Utah Health

Body temperature was decreased to a target of 33 degrees Celsius in half of the children (hypothermia) for 48 hours, and fever was prevented in the other half (normothermia). Survival was similar in both groups after up to one year of follow-up.

Hypothermia (lowering the body temperature to subnormal levels) after cardiac arrest became standard practice in adult and neonatal critical care in the early 2000s, but its benefits in children were unknown. To answer this question, University of Utah Health researcher J. Michael Dean, MD, and colleagues conducted two randomized trials (in-hospital and out-of-hospital) at 38 U.S. and international sites, comparing hypothermia with normothermia—maintenance of normal body temperature—after cardiac arrest. Over 4,000 children were screened and 624 participated in the trials. In both trials, researchers found no benefit from hypothermia versus normothermia.

Previous trials had observed frequent fever in the patients who were not treated with hypothermia after cardiac arrest. Dean and colleagues introduced an important innovation in their trials: active treatment of participants in the normothermia group with temperature control mattresses to prevent fever. This unique approach yielded the key insight that, after cardiac arrest, it is the prevention of fever, and not the induction of hypothermia, that plays a critical role in determining the ultimate health and neurological outcomes of survivors.

Key U of U Health Collaborator:

Richard Holubkov, PhD, Pediatrics

References:

Therapeutic hypothermia after out-of-hospital cardiac arrest in children. Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Clark AE, Browning B, Pemberton VL, Page K, Shankaran S, Hutchison JS, Newth CJ, Bennett KS, Berger JT, Topjian A, Pineda JA, Koch JD, Schleien CL, Dalton HJ, Ofori-Amanfo G, Goodman DM, Fink EL, McQuillen P, Zimmerman JJ, Thomas NJ, van der Jagt EW, Porter MB, Meyer MT, Harrison R, Pham N, Schwarz AJ, Nowak JE, Alten J, Wheeler DS, Bhalala US, Lidsky K, Lloyd E, Mathur M, Shah S, Wu T, Theodorou AA, Sanders RC Jr, Dean JM; THAPCA Trial Investigators. N Engl J Med. 2015 May 14;372(20):1898-908.

Therapeutic hypothermia after in-hospital cardiac arrest in children. Moler FW, Silverstein FS, Holubkov R, Slomine BS, Christensen JR, Nadkarni VM, Meert KL, Cl, Browning B, Pemberton VL, Page K, Gildea MR, Scholefield BR, Shankaran S, Hutchison JS, Berger JT , Ofori-Amanfo G, Newth CJ, Topjian A, Bennett KS, Pineda JA, Koch JD, Pham N, Chanani NK, Harrison R, Dalton HJ, Alten J, Schleien CL, Goodman DM, Zimmerman JJ, Bhalala US, Schwarz AJ, Porter MB, Shah S, Fink EL, McQuillen P, Wu T, Skellet S, Thomas NJ, Nowak JE, Baines PB, Pappachan J, Mathur M, Lloyd R, van der Jagt EW, Dobyns EL, Meyer MT, Sanders RC, Clark AE, Dean JM; THAPCA Trial Investigators. N Engl J Med. 2017 Jan 24;376:318-329.

Acute kidney injury after in-hospital cardiac arrest. Mah KE, Alten JA, Cornell TT, Selewski DT, Askenazi D, Fitzgerald JC, Topjian A, Page K, Holubkov R, Slomine BS, Christensen JR, Dean JM, Moler FW. Resuscitation. 2021 Mar;160:49-58.