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Klin Padiatr 2014; 226(04): 221-224
DOI: 10.1055/s-0034-1375699
Case Report
© Georg Thieme Verlag KG Stuttgart · New York

Therapeutic Hypothermia after Cardiopulmonary Resuscitation in a 4-month Infant

Therapeutische Hypothermie nach kardiopulmonaler Reanimation bei einem 4 Monate alten Säugling
G. Warncke
1   Children’s University Hospital, Pediatric Intensive Care Unit, Rostock, Germany
,
U. N. Osmers
2   Department of Anaesthesiology and Intensive Care Medicine, Medical Center Südstadt, Rostock, Rostock, Germany
,
C. Hauenstein
3   Deparment of Diagnostic and Interventional Radiography, University Hospital, Rostock, Germany
,
M. Scotland
1   Children’s University Hospital, Pediatric Intensive Care Unit, Rostock, Germany
,
H. von Osten
1   Children’s University Hospital, Pediatric Intensive Care Unit, Rostock, Germany
,
R. Höhn
1   Children’s University Hospital, Pediatric Intensive Care Unit, Rostock, Germany
,
D. C. Fischer
4   Children’s University Hospital, Rostock, Germany
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Publikationsdatum:
10. Juli 2014 (online)

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Abstract

Therapeutic hypothermia is currently recommended for adult comatose survivors of cardiac arrest and perinatal hypoxic-ischemic encephalopathy. By contrast, current international guidelines on cardiopulmonary resuscitation in children neither refute nor support therapeutic hypothermia. Here we report on a 4-month old infant who survived resuscitation for severe cardiopulmonary insufficiency without neurological impairments. The infant most probably experienced unwitnessed aspiration with subsequent severe cardiopulmonary insufficiency. This was paralleled by incidental hypothermia, i. e. a core body temperature of 32°C at time of resuscitation. The infant was transported to the pediatric intensive care unit and additional to state-of the art resuscitation therapy (e. g. vasopressors, pressure controlled intermittent mandatory ventilation) therapeutic hypothermia (core body temperature 32.0–34.0°C) was admininistered for additional 48 h to confer optimal neuroprotection. Subsequently, he was rewarmed (0.25°C per hour) and sedation was stopped at a core body temperature of 36°C. Chest X-ray at time of admission to the hospital revealed typical signs of severe aspiration, whereas transthoraic echocardiography, electrocardiography and ultrasound examination of the brain were without pathological findings. Likewise, magnetic resonance imaging of the head performed on days 3 and 32 after resuscitation revealed no signs of hypoxic brain damage and the child was discharged to foster care without neurological deficits 52 days after admission.

Zusammenfassung

Die therapeutische Hypothermie (THT) wird bei Erwachsenen nach erfolgreicher Reanimation z. B. nach Herz-Kreislauf-Stillstand oder in der Altersgruppe der Neugeborenen bei hypoxisch-ischämischer Enzephalopathie seit vielen Jahren erfolgreich angewendet. Im Gegensatz dazu wird die THT in den aktuellen Empfehlungen des European Resuscitation Council (ERC) zur kardiopulmonalen Reanimation für Kinder weder abgelehnt noch eindeutig empfohlen.

Wir berichten über einen 4 Monate alten Säug­ling, der eine schwere kardiopulmonale Insuffizienz nach Reanimation ohne neurologische Beeinträchtigungen überlebte. Vermutlich durch eine Aspiration bedingt kam es in der Folge zu einer schweren Beeinträchtigung des Herz-Kreislauf-Systems sowie der Atmung. Bereits zu Beginn der Reanimation war eine akzidentelle Hypothermie mit einer Körperkerntemperatur von 32°C nachweisbar. Der Säugling wurde auf unsere interdisziplinäre pädiatrische Intensivstation eingewiesen. Dort führten wir neben einer kreislauf- und atemstabilisierenden Therapie eine therapeutische Hypothermie (Körperkerntemperatur 32,0–34,0°C) mit dem Ziel einer maxi­malen Neuroprotektion für 48 Stunden durch. Im Anschluss wurde der Patient mit 0,25°C pro Stunde wieder erwärmt und die Sedierung bei einer Körperkerntemperatur von 36°C beendet. Die Röntgenaufnahme des Thorax wies das typische Bild einer schweren Aspiration auf, wohingegen Echokardiografie, EKG, Sonografie des ZNS keine pathologischen Befunde auswie­sen. In der an Tag 3 und 32 nach Reanimation durchgeführten kernspintomo­grafischen Untersuchung waren keine hypoxischen Hirnschäden nachweisbar. Der Säugling wurde 52 Tage nach dem Ereignis ohne neurologische Defizite in eine Pflege entlassen.

Key words

therapeutic hypothermia - pediatric cardiac arrest - resuscitation - infant

Schlüsselwörter

therapeutische Hypothermie - Herz-Kreislaufstillstand im Kindesalter - Wiederbelebung - Säugling
 

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