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Survey of the use of therapeutic hypothermia after cardiac arrest in UK paediatric emergency departments
  1. Barnaby R Scholefield1,
  2. Mark D Lyttle2,
  3. Kathleen Berry3,
  4. Heather P Duncan1,
  5. Kevin P Morris1
  1. 1Paediatric Intensive Care Unit, Birmingham Children's Hospital, Birmingham, UK
  2. 2Emergency Department, Royal Children's Hospital, Parkville Victoria, Melbourne, Victoria, Australia
  3. 3Paediatric Emergency Department, Birmingham Children's Hospital, Birmingham, UK
  1. Correspondence to Dr Barnaby R Scholefield, Paediatric Intensive Care Unit, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK; barnaby.scholefield{at}bch.nhs.uk

Abstract

Objectives To ascertain current use of therapeutic hypothermia (TH) after paediatric cardiac arrest in UK emergency departments (EDs), and views on participating in a UK randomised controlled trial (RCT) incorporating early induction of TH in ED.

Design Anonymous web-based survey of 77 UK Emergency Medicine (EM) consultants from 28 UK EDs that see children during the period April–June 2010.

Results 62% (48/77) of surveyed consultants responded from 21/28 (75%) EDs. All managed children post cardiac arrest. 90% (43/48) were aware of the literature concerning TH after cardiac arrest in adults. However, 63% (30/48) had never used TH in paediatric practice. All departments had at least one method of inducing TH (surface cooling; air/water blankets; intravenous cold fluid or catheters). Reasons stated for not inducing TH included no equipment available (26%; 11/42), TH not advocated by the local PICU (24%; 10/42) and not enough evidence for its use (24%; 10/42). TH was considered based on advice from the local Paediatric Intensive Care Units (68%; 17/25) or likelihood of recovery after arrest (32%; 8/25). There was strong support for a UK RCT of TH versus normothermia (85%; 40/47). The proposed RCT was felt to be ethical (87%; 40/48) with use of deferred consent acceptable (74%; 34/46).

Conclusion UK EM consultants are aware of TH but infrequently initiate the therapy in children for a number of reasons. Their involvement would enable early induction of TH in EDs after paediatric cardiac arrest during a UK RCT. The authors have demonstrated the availability of suitable equipment and EM consultant support for participation in such a RCT.

  • Paediatrics
  • emergency medicine
  • cardiac arrest
  • hypothermia
  • paediatric emergency medicine
  • resuscitation
  • research
  • clinical care
  • emergency department

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Footnotes

  • Competing interests None.

  • Ethics approval This study was a service evaluation via a survey of medical practitioners working in emergency medicine in the UK; we, therefore, were satisfied that ethics committee approval was not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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