Discoveries – Page 6 – 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.

Press Releases and Media:

University of Utah Health: “Study Calls Into Question Inducing Hypothermia to Treat Cardiac Arrest In Children“; “Body Cooling vs. Active Fever Prevention: Similar Outcomes for Children After in-Hospital Cardiac Arrest“

Health Medicine Network
Health Day
Science Daily
News Medical.net

Lowering Body Temperature After Cardiac Arrest | PI: J. Michael Dean, MD

Graphic- Readmission Destination and the Risk of Mortality Following Major Surgery — Readmission to the index hospital and continuity of care provided by the original team were associated with lower in-hospital mortality and 90-day mortality following major surgery and rehospitalization.

Identification of factors that define surgical quality traditionally centers on where operations take place, who performs the operations, and events which occur while the patient is in the hospital. Far less attention focuses on events which occur after patients leave the hospital. However, complications following major surgery frequently arise after patients are discharged, and up to 25% of patients who undergo major surgery will require readmission.

University of Utah Health investigator Benjamin Brooke, MD, PhD, and colleagues sought to determine whether patients who are readmitted following major surgery achieve better outcomes if they return to the same hospital and surgeons who performed their initial operation. They used Medicare claims data from over 9 million beneficiaries to identify patients who were readmitted within 30 days following a major surgery across all specialties. They found that when complications arose, patients who returned to the index hospital and received care from their original surgical team achieved significantly greater 90-day survival than those whose readmission occurred at a different hospital. These findings suggest the importance of continuity of care following surgery as a measure of quality.