Scholefield, Barnaby R. (2012) The feasibility of performing a randomised controlled trial of therapeutic hypothermia for neuroprotection after paediatric cardiac arrest in the UK. PhD thesis, University of Warwick.

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Abstract

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.

Item Type:	Thesis or Dissertation (PhD)
Subjects:	R Medicine > R Medicine (General) R Medicine > RJ Pediatrics
Library of Congress Subject Headings (LCSH):	Clinical trials -- Great Britain, Cardiac arrest in children -- Cryotherapy -- Great Britain, Hypothermia, Induced
Official Date:	August 2012
Dates:	Date Event August 2012 Submitted
Institution:	University of Warwick
Theses Department:	Warwick Medical School
Thesis Type:	PhD
Publication Status:	Unpublished
Supervisor(s)/Advisor:	[Not provided]
Sponsors:	Birmingham Children's Hospital
Extent:	361 leaves : charts.
Language:	eng

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