Note that some pediatricians remain cautious about using therapeutic hypothermia, because long-term data on the safety and efficacy of the practice have not been reported.
Therapeutic hypothermia for cardiac arrest and coma in adults
A devastating complication of cardiac arrest is coma and long-term neurologic dysfunction. Randomized trials have reported that therapeutic hypothermia is beneficial for comatose survivors of cardiac arrest.
In one study, 275 comatose survivors of cardiac arrest were randomized to therapeutic hypothermia (core temperature, 32°C to 34°C) or usual care. At 6 months, mortality was 41% in the hypothermia group and 55% in the usual care group (risk ratio 0.74; 95% Ci, 0.58–0.95). At 6 months, the rate of favorable neurologic recovery among survivors was 93% in those who had been treated with hypothermia and 87% in those given usual care.1
One protocol for inducing moderate hypothermia that has been studied in adults is to infuse, intravenously, approximately 2 L of cold (4°C) lactated Ringer’s solution and to cover the body with refrigerated cooling pads. The typical target is a core temperature of 32°C to 34°C, maintained for 24 hours.
Reference
1. The Hypothermia after Cardiac Arrest Study Group Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346(8):549-556.
Impact on your practice
For decades, newborns in neonatal intensive care units received their care in warm incubators designed to maintain a body temperature of approximately 37°C. Could the standard practice of warming newborns have contributed to neurologic problems in those who suffered hypoxic-ischemic injury?
Whole-body cooling appears to reduce the rate of cerebral palsy in newborns after hypoxic-ischemic injury. For OBs, this treatment could significantly reduce their exposure to litigation that is based on a theory of hypoxic-ischemic birth injury—by reducing the number of surviving infants who have cerebral palsy.
Does your nursery have a protocol for rapidly instituting therapeutic cooling?
How does the partial pressure of arterial oxygen (PaO2) in a newborn compare with that of an adult breathing ambient air near the summit of Mount Everest?
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