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PedsCrit
Post–Cardiac Arrest Syndrome with Dr. Alexis Topjian-Part 2
Jan 8, 2024
Dr. Alexis Topjian discusses post-cardiac arrest care, including therapeutic hypothermia trials in pediatric patients and the impact of temperature management on outcomes. The podcast also highlights the importance of clinical pathways, neuro-prognostication, and building systems to improve patient care.
26:40
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Quick takeaways
- Cooling to 33 degrees Celsius in post-cardiac arrest care may not significantly improve outcomes compared to maintaining temperature at 36 degrees, but there is a higher percentage of favorable outcomes in the 33-degree group for pediatric patients.
- Careful monitoring of physiological changes during cooling and rewarming phases is crucial, including considerations of heart rate, systemic vascular resistance, fluid management, insulin administration, and electrolyte assessments.
Deep dives
Cooling and Targeted Temperature Management in Pediatric Post-Cardiac Arrest Care
One of the main topics discussed in this episode is the use of cooling or targeted temperature management in post-cardiac arrest care. The speaker explains that cooling to 33 degrees Celsius was initially thought to improve outcomes based on adult cooling trials in the early 2000s. However, recent trials in adults have shown no significant difference in outcomes between patients treated with targeted temperature management at 33 degrees and those maintained at 36 degrees. On the pediatric side, the FAP trial revealed no difference between cooling to 33 degrees and maintaining normal temperature at 36.8 degrees for children after out-of-hospital cardiac arrest. However, the trial did show a higher percentage of favorable outcomes in the 33-degree group. As a result, some centers have adopted a personalized approach, allowing providers to choose between cooling to 33 or maintaining temperature at 36.8 based on their own interpretations of the data. It is important to note that cooling is just one component of post-arrest care, and a comprehensive bundle of care is provided to all patients, regardless of the temperature targeted.
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