• Mauricio Yunge, Jaime Cordero, Daniela Martinez, Raul Bustos, Adriana Wegner, Magdalena Castro, Lorena Arrau, Betsy Diaz, Roberto Dalmazzo, Lilian Hickmann, Michelangelo Lapadula, Leticia Yañez, Jorge Roque, Corrado Cecchetti, Pablo Bravo, Pablo Cruces, Carlos Acuña, Pablo Oyaguez, Alicia Miras, Antonio Morales, Manuel Nieto, Yolanda Lopez, Gonzalo Morales, Michele Drago, Maria Elisa Nalegach, German Sepulveda, Amanda Menchaca, Florencia Jerez, Maritza Glasinovic, Fernando Mallea, and Jesus Lopez-Herce.
• PICU, Clinica Las Condes, Santiago, Chile.
• Pediatr Crit Care Me. 2019 Feb 1; 20 (2): e77-e82.

ObjectivesIt is currently recommended that after return of spontaneous circulation following cardiac arrest, fever should be prevented using TTM through a servo-controlled system. This technology is not yet available in many global settings, where manual physical measures without servo-control is the only option. Our aim was to compare feasibility, safety and quality assurance of servo-controlled system versus no servo-controlled system cooling, TTM protocols for cooling, maintenance and rewarming following return of spontaneous circulation after cardiac arrest in children.DesignProspective, multicenter, nonrandomized, study.SettingPICUs of 20 hospitals in South America, Spain, and Italy, 2012-2014.PatientsUnder 18 years old with a cardiac arrest longer than 2 minutes, in coma and surviving to PICU admission requiring mechanical ventilation were included.MethodsTTM to 32-34°C was performed by prospectively designed protocol across 20 centers, with either servo-controlled system or no servo-controlled system methods, depending on servo-controlled system availability. We analyzed clinical data, cardiac arrest, temperature, mechanical ventilation duration, length of hospitalization, complications, survival, and neurologic outcomes at 6 months.Primary Outcomefeasibility, safety and quality assurance of the cooling technique and secondary outcome: survival and Pediatric Cerebral Performance Category at 6 months.Measurements And Main ResultsSeventy patients were recruited, 51 of 70 TTM (72.8%) with servo-controlled system. TTM induction, maintenance, and rewarming were feasible in both groups. Servo-controlled system was more effective than no servo-controlled system in maintaining TTM (69 vs 60%; p = 0.004). Servo-controlled system had fewer temperatures above 38.1°C during the 5 days of TTM (0.1% vs 2.9%; p < 0.001). No differences in mortality, complications, length of mechanical ventilation and of stay, or neurologic sequelae were found between the two groups.ConclusionsTTM protocol (for cooling, maintenance and rewarming) following return of spontaneous circulation after cardiac arrest in children was feasible and safe with both servo-controlled system and no servo-controlled system techniques. Achieving, maintaining, and rewarming within protocol targets were more effective with servo-controlled system versus no servo-controlled system techniques.

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