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The feasibility of performing a randomised controlled trial of therapeutic hypothermia for neuroprotection after paediatric cardiac arrest in the UK
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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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WRAP_THESIS_Scholefield_2013.pdf - Submitted Version Download (7Mb) | Preview |
Official URL: http://webcat.warwick.ac.uk/record=b2690948~S1
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 (PhD) | ||||
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Subjects: | R Medicine > R Medicine (General) R Medicine > RJ Pediatrics |
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Library of Congress Subject Headings (LCSH): | Clinical trials -- Great Britain, Cardiac arrest in children -- Cryotherapy -- Great Britain, Hypothermia, Induced | ||||
Official Date: | August 2012 | ||||
Dates: |
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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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