Abstract
Aim
Children surviving cardiac arrest (CA) lack proven neuroprotective therapies. The
role of biomarkers in assessing response to interventions is unknown. We hypothesized
that 72 versus 24 h of hypothermia (HT) would produce more favorable biomarker profiles
after pediatric CA.
Methods
This single center pilot randomized trial tested HT (33 ± 1 °C) for 24 vs. 72 h in
34 children with CA. Children comatose after return of circulation aged 1 week to
17 years and treated with HT by their physician were eligible. Serum was collected
twice daily on days 1–4 and once on day 7. Mortality was assessed at 6 months.
Results
Patient characteristics, baseline biomarker concentrations, and adverse events were
similar between groups. Eight (47%) and 4 (24%) children died in the 24 h and 72 h
groups, p = .3. Serum neuron specific enolase (NSE) concentration was increased in
the 24 vs. 72 h group at 84 h–96 h (median [interquartile range] 47.7 [3.9, 79.9]
vs. 1.4 [0.0, 11.1] ng/ml, p = .02) and on day 7 (18.2 [3.2, 74.0] vs. 2.6 [0.0, 12.8]
ng/ml, p = .047). Serum S100b was increased in the 24 h vs. 72 h group at 12 h–24 h,
36 h–84 h, and on day 7, all p < 0.05. HT duration was associated with S100b (but
not NSE or MBP) concentration on day 7 in multivariate analyses.
Conclusion
Serum biomarkers show promise as theragnostic tools in pediatric CA. Our biomarker
and safety data also suggest that 72 h duration after pediatric CA warrants additional
exploration.
Abbreviations:
HT (hypothermia), PICU (pediatric intensive care unit), RCT (randomized controlled trial), PCPCscore (Pediatric Cerebral Performance Category)Keywords
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Article info
Publication history
Published online: February 15, 2018
Accepted:
February 9,
2018
Received in revised form:
January 19,
2018
Received:
August 12,
2017
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.02.008.
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
