I think that in PICU, body and brain hypothermia in well controlled situation (begin as soon as possible, barbiturates, inubation and longer than 72 hrs) reduces the inflammatory cascade.

It depends on whether you want to practice based on "evidence-based-medicine" or not. If the RCT showed no benefit except spending more money on cooling the patients then I will say the study did not favor such practice and I will stop doing so. For patients in PICU are totally different since we know when the cardiac arrest happen.  

Based on the results, the answer is No.

For out of hospital Pediatric arrest, I think therapeutic hypothermia maybe offered only as a research project. Parents need to have informed consent before such therapy is initiated. 

Promptly engaging in targeted temperature management is appropriate in pediatric cardiac arrest patients.  Based upon the results of THAPCA--OH as well as the adult TTM trial from 2013 there's no apparent benefit in bringing them down to 33C, rather, either targeting 36.8C (as per THAPCA protocol) or 36.0C (as per TTM protocol) seems to be appropriate.  In my hospital the present protocol is to engage in targeted temperature management at 36.0C for 72 hours following return of circulation.

Here's a link to a set of slides from a talk I gave to a nursing conference here (a handful of days before THAPCA-OH was published)--the bibliography at the end has relevant references. 

http://goo.gl/uc9chD 

http://goo.gl/uc9chD

Jeffrey ....thanks for your comments and the slides 

Raúl 

In lab，younger mice are well tolerated to hypoxia than elder. So......

I would be careful before interpreting the results of the THAPCA trial as negative here.  I think there will be a lot of debate over the way this was reported. The main concern I see is that to say the findings aren't "significant" is dubious. From a purely statistical standpoint (and classical/frequentist, at that, which itself brings up the unfortunate fact that we're not doing studies such as this in more advanced Bayesian Adaptive approaches...) this may be correct for some of the measures. But from the point estimates, we're looking at a Number Needed to Treat (NNT) of 12.5 (20% vs. 12% to primary outcome of survival at 12 months after cardiac arrest with a VABS-II score of 70 or higher). This is amazing. And an overall 1-year survival of 38% in the hypothermia group vs. 29% in the normothermia group gives us an NNT of 11.

This was clearly underpowered to find the statistical significance, but that shouldn't affect the obvious effect size signal. The goal was 276 patients, the analyzed number was short of that, and the sensitivity analysis (reported only in the Supplementary Appendix), despite being downplayed by the authors, suggests that in fact the statistical results were quite close to crossing into significance had the trial ran a bit longer. For some reason, the authors also buried a statistically significant finding in an appendix: "Survival over time was significantly longer with therapeutic hypothermia than with therapeutic normothermia (mean survival, 149±14 days vs. 119±14 days; P = 0.04 for the comparison of survival between the two treatment groups by means of the log-rank test) (Fig. S1 in the Supplementary Appendix)." Looking at Figure S1 (way down on page 22 of the Supplementary Appendix), I think it's pretty clear which arm you'd put your loved one in if faced with that decision.  

Finally, it's important to note (and fortunately the authors are good at emphasizing this) that this was not a study against a non-treated arm, but rather was a comparison between two very rigorously treated arms (for out to 120 hours), with one arm being colder than the other, but both arms being carefully treated to maintain a goal temperature, and avoid febrile/hyperthermic excursions which are generally agreed upon to be detrimental to outcome.  

I think it would be useful, if begining as soon as possible, like to those cooled asphyctic newborn infants when combinated with adjunct teatments such as allopurinol, melatonin.

THAPCA study included infants and children typically  from causes such as strangulation, drowning, or trauma. A separate study by the same researchers is examining body cooling in hospitalized patients who suffer cardiac arrest, typically as a complication of a medical condition. A goal of both studies is preventing fever, which commonly occurs after cardiac arrest and can lead to more severe outcomes.

No. I have lived through three waves of enthusiasm for hypothermia, and they have ultimately all come to the same conclusion: the patients seem to do well while they are cooled, but when you rewarm them, the outcome is dismal. The benefit of hypothermia for pediatric arrest seems to be in the cases of near drowning in cold water: children who drown in cold water have some mysterious survivals, while children who drown in warm water, ie heated swimming pool, do terribly. I saw five children who drowned in Lake Michigan, all recover, but all five died in about a week of overwhelming sepsis; Lake Michigan is apparently very contaminated. Other causes of pediatric cardiac arrest seem to be generalized as hypoxia, and I cannot think of any reason why hypothermia would rescue an already destroyed brain.

You are right, Dr Peter. Paediatric cardiac arrest do dismally after rewarming, ending with brain stem death more than cortical or Brain death

No!. I prefere to control temperature ( do not increse over normal) but not induce hypothermia. The metabolic consequences are so extended in children and benefits are smaller than adultd, so, succesfull cerebral resuscitation to children are dependent to metabolic brain damages prevention ( hipo.hiper glicemia, electrolytes disturbances, ICP controll, cerebral flow related ventilation)