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PEDIATRICS Vol. 106 No. 1 July 2000, pp. 118-122

Hypothermia and Hyperthermia in Children After Resuscitation From Cardiac Arrest

Received Aug 9, 1999; accepted Nov 22, 1999.

Robert W. Hickey*, Patrick M. KochanekDagger , Howard Ferimer§, Steven H. Grahamparallel , and Peter SafarDagger

From * Children's Hospital of Pittsburgh, Department of Pediatrics, Division of Pediatric Emergency Medicine; Dagger  University of Pittsburgh, Departments of Anesthesia/Critical Care Medicine and the Safar Center for Resuscitation Research; § Mercy Hospital, Department of Pediatrics; and parallel  Geriatric Research Educational and Clinical Center, VA Pittsburgh Health System and the University of Pittsburgh, Department of Neurology, Pittsburgh, Pennsylvania.

Objective.  In experimental models of ischemic-anoxic brain injury, changes in body temperature after the insult have a profound influence on neurologic outcome. Specifically, hypothermia ameliorates whereas hyperthermia exacerbates neurologic injury. Accordingly, we sought to determine the temperature changes occurring in children after resuscitation from cardiac arrest.

Study Design.  The clinical records of 13 children resuscitated from cardiac arrest were analyzed. Patients were identified through the emergency department and pediatric intensive care unit arrest logs. Only patients surviving for >= 12 hours after resuscitation were considered for analysis. Charts were reviewed for body temperatures, warming or cooling interventions, antipyretic and antimicrobial administration, and evidence of infection.

Results.  Seven patients had a minimum temperature (T min) of <= 35°C and 11 had a maximum temperature (T max) of >= 38.1°C. Hypothermia often preceded hyperthermia. All 7 patients with T min <= 35°C were actively warmed with heating lamps and 5 of 7 responded to warming with a rebound of body temperatures >= 38.1°C. None of the 6 patients with T min >35°C were actively warmed but all developed T max >= 38.1°C. Six patients received antipyretics and 11 received antibiotics. Fever was not associated with a positive culture in any case.

Conclusion.  Spontaneous hypothermia followed by hyperthermia is common after resuscitation from cardiac arrest. Temperature should be closely monitored after cardiac arrest and fever should be managed expectantly.  Key words:  cardiac arrest, temperature, fever, hypothermia.




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