Phoenix Children’s studying Body Cooling in Children after Cardiac Arrest, including Drowning Victims

National Institute of Health funds study to explore the use of temperature regulation in infants & children

PHOENIX, Ariz. (Sept. 12, 2011)  Phoenix Children’s has long been known for innovative programming to prevent child drownings, but few may realize that the hospital has been participating in an effort to investigate what effect body cooling, or hypothermia, may have on drowning victims.

Critical care pediatricians from Phoenix Children’s, along with 33 other top children’s hospitals in the U.S. and Canada, are studying the effects of body cooling, or hypothermia, on children who suffer a cardiac arrest. Cardiac arrest has many causes, such as strangulation, drowning, trauma or a complication of many medical conditions. Cardiac arrest interrupts oxygen supply to the brain, causing inflammation and cell death, which can lead to often irreversible neurological damage.

“The study will help us further understand if reducing a child’s body temperature can improve outcome in terms of brain recovery after a cardiac arrest,” says Heidi Dalton, Chief of Critical Care Medicine at Phoenix Children’s and an investigator in the trials.

Last October, the National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, launched this first large-scale, multi-center study to investigate the effectiveness of body cooling treatment in infants and children who have had cardiac arrest. The Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials funding totals more than $21 million over six years.

"There has been some data showing the benefits of hypothermia in adults with cardiac arrest, but mainly in those with a sudden cardiac arrest from ventricular fibrillation, which is a relatively uncommon cause of arrest in children. There is also some evidence that hypothermia in newborns with asphyxia following birth may benefit brain recovery, but the data is not completely clear. There is little data in children following arrest, with some small reports saying it helps and others finding no benefit,” said Dalton.

“This study will help answer the question if hypothermia is good, bad or no benefit in children suffering a cardiac arrest, and may lead to evidence-based guidelines that can improve rates of survival as well as improve neurologic outcome. One unique part of this study is that survivors all receive neurodevelopmental testing a year after arrest to assess their neurodevelopmental recovery. There is very little long term outcome information such as this in children so far.” Phoenix Children’s has already had 15 children enrolled in the studies and is the only hospital in Maricopa County participating. Nationally, over 230 children out of a goal of 900 total have been enrolled.

The THAPCA project requires parent or guardian consent. If the family consents and the patient meets eligibility criteria, of which the most difficult to manage is the fact that the patient must be enrolled in the study within 6 hours after the arrest, the patient is randomly assigned to one of the two treatment groups. The therapeutic hypothermia group receives “hypothermia,” or cooling treatment for two days, and then “normothermia” treatment, or normal temperature, for three days, ensuring the body temperature is kept within a normal temperature range. Participants in the therapeutic normothermia groups receive normothermia treatment for all five days. No other changes in patient care are made except for temperature management for 5 days. Participants will undergo neurological and behavioral testing a year after the cardiac arrest.

This study is only one of several national projects that Phoenix Children’s Hospital is involved in. Learning more about diseases and optimizing treatment regimens to improve outcomes for children and their families is another example of how Critical Care Medicine at PCH is continuing its work in being 100% for children.

Arizona falls just behind number-one ranked Florida for drownings in swimming pools, according to Centers for Disease Control data released this summer. To date this year, fifteen children and two teens have drowned in Maricopa County alone. “Prevention is critical,” says Dr. Dalton, “and we urge parents to take steps to keep their children from needing medical attention for a drowning.”

Important steps to prevent a child drowning include:

• Assigning a constant, capable Water Watcher to supervise children when they have access to water.
• Placing barriers, such as pool fences, between children and the water.
• Teaching children to swim at the appropriate age, and keeping adult CPR skills sharp.

The THAPCA trials are being conducted in partnership with the Collaborative Pediatric Critical Care Research Network, established in 2004 by the NIH's Eunice Kennedy Shriver National Institute of Child Health and Human Development, and the Pediatric Emergency Care Applied Research Network, established in 2001 by the Health Resources and Services Administration’s Maternal and Child Health Bureau.

About Phoenix Children’s Hospital

Phoenix Children’s Hospital, ranked in U.S. News & World Report’s Best Children’s Hospitals, is Arizona’s only licensed children’s hospital, providing world-class care in more than 40 pediatric specialties to children from throughout the state and region. Phoenix Children’s is in the midst of a major expansion to meet the needs of the Southwest’s rapid population growth. The signature element of the expansion is a new 11-story, 750,000-square-foot tower which will enable the hospital to grow from 345 licensed beds today to a total of 626 licensed beds once the project is complete. The hospital’s expansion also includes an aggressive physician recruitment effort and new satellite centers in high growth areas of the Valley.

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