Cardiac arrest in paediatric patients often results in death or survival with severe brain injury. Therapeutic hypothermia, lowering of core body temperature to 32 to 34⁰C may reduce injury to the brain in the period after circulation has been restored. This thesis comprises studies related to the feasibility of performing a randomised controlled trial (RCT) of therapeutic hypothermia for neuroprotection after cardiac arrest in the UK. A systematic Cochrane review of paediatric evidence finds no published RCTs supporting or refuting the use of therapeutic hypothermia after cardiac arrest. Four on-going RCTs are identified which will add to the future evidence base; however, a future UK RCT is recommended. Additional support for a RCT is demonstrated by two UK surveys of paediatric intensive care and emergency care clinicians. Current UK practice is varied and clinical equipoise exists regarding post cardiac arrest temperature management. A national, retrospective study of all admissions to paediatric intensive care after out of hospital (OHCA) and in hospital cardiac arrest (IHCA) shows an overall survival of 76 and 50% respectively. Important differences between IHCA and OHCA populations are identified, recommending separation in a RCT. The incidence rate of cardiac arrest admissions to PICU in the UK is too low to recruit to a UK only RCT, after consideration of sample size requirements. A large, multi-centre, retrospective, observational study of OHCA patients identified multiple factors associated with survival. A survival prediction model, incorporating: pupillary reaction, blood lactate level and duration of cardiac arrest, is described. The model could be used as a tool for stratified randomisation within a RCT. Finally, therapeutic hypothermia is retrospectively compared with standard, normothermic temperature management after OHCA. In a limited population, no difference in survival is found; however, important information on application, logistics and safety of the intervention are evaluated.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:582349 |
| Date | January 2012 |
| Creators | Scholefield, Barnaby R. |
| Publisher | University of Warwick |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
| Source | http://wrap.warwick.ac.uk/57933/ |
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