From the Guidelines
The temperature goal for pediatric patients after cardiopulmonary resuscitation is to maintain normothermia, which means keeping the body temperature between 36-37.5°C (96.8-99.5°F). Active fever prevention is recommended rather than therapeutic hypothermia. If a child develops fever (temperature >38°C or 100.4°F) after return of spontaneous circulation, it should be treated with antipyretics such as acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (10 mg/kg every 6-8 hours) and external cooling measures if needed. This approach is supported by the 2019 American Heart Association guidelines update, which suggests that maintaining normothermia provides similar neurological outcomes to therapeutic hypothermia but with fewer complications 1.
Some key points to consider in post-CPR temperature management for pediatric patients include:
- Continuous temperature monitoring is essential, typically using rectal, esophageal, or bladder temperature probes for accurate core temperature measurement.
- The goal is to prevent secondary brain injury while supporting cardiovascular stability during the critical post-resuscitation period.
- Current evidence suggests that actively maintaining normothermia provides similar neurological outcomes to therapeutic hypothermia but with fewer complications such as arrhythmias, coagulopathies, and increased infection risk 1.
- Previous practices that favored therapeutic hypothermia (32-34°C) are no longer recommended as the primary approach for pediatric patients post-CPR.
It's worth noting that while therapeutic hypothermia may have been considered in the past for certain cases, the current consensus, as reflected in the most recent guidelines, leans towards maintaining normothermia as the standard of care for pediatric patients after cardiopulmonary resuscitation 1.
From the Research
Temperature Goals for Pediatric Patients Post-Cardiopulmonary Resuscitation (CPR)
- The ideal temperature goal for pediatric patients post-CPR is a topic of ongoing research and debate 2, 3, 4, 5, 6.
- Targeted temperature management (TTM) is a crucial aspect of neurocritical care, encompassing therapeutic hypothermia, controlled normothermia, and treatment of fever 3, 6.
- In pediatric patients with acute neurological injury, maintaining normothermia is essential to prevent exacerbation of increased intracranial pressures and negative effects on perfusion pressure and cerebral blood flow 2.
- The American Heart Association recommends targeted temperature management for pediatric patients after cardiac arrest, with a goal temperature range of 32-34°C or 36-37.5°C 4.
- However, the optimal timing and duration of temperature management are still unclear, with some studies suggesting that earlier achievement of goal temperature may not necessarily lead to better outcomes 4.
- A study published in 2019 found that the median time from return of spontaneous circulation (ROSC) to goal temperature was 7.4 hours, with no significant difference in outcomes between patients who achieved goal temperature earlier or later 4.
- Another study published in 2017 provided an evidence-based guideline for the implementation of targeted temperature management in neurocritical care, including recommendations for cooling techniques, rate of cooling, and patient monitoring 6.
- The guideline emphasizes the importance of individualizing temperature management to each patient's needs and circumstances, taking into account factors such as the underlying cause of cardiac arrest, the presence of other injuries or illnesses, and the patient's overall clinical condition 6.