Doctor: I’m really sorry, but your child may have serious brain damage as a result of his cardiac arrest.Parent: That’s terrible! Isn’t there anything we can do?Doctor: I’m afraid not. There are some interventions that have been suggested, but they’ve not been shown to be effective.Parent: What interventions?Doctor: Well, cooling the body for a couple of days, for example. It’s been tried in neonates with birth asphyxia and adults after cardiac arrest.Parent: But … if this intervention is used in neonates and adults, how can you say it won’t work in children?Doctor: Well, in a recent study including almost 300 children, 20 % of those who were cooled survived with good brain function versus just 12 % of those who weren’t cooled. Neurological status improved in 38 % of the cooled children compared with only 29 % of the non-cooled. And, 28 days after the arrest, the mortality rate was 10 % lower in cooled children (57 % versus 67 %). Unfortunately, when the researchers applied the standard statistical rules that we use to interpret all scientific research, there was more than a 10 % possibility that these differences were due to chance, so we can’t recommend it.Parent: But those results are really encouraging. Even if statistics tell you that this may be due to chance, there’s still the possibility that it wasn’t and I’d like my child to have that opportunity. Maybe the treatment’s expensive?Doctor: No, that’s not the issue.Parent: Was it dangerous then?Doctor: Quite safe actually. Potassium and platelet levels went down a little, but with no harmful consequences. There is a risk that the heart rhythm can be affected; some of these abnormalities can even be quite dangerous. In the same study, serious abnormalities of the heart rhythm occurred in 11 % of the cooled children and 9 % of the others. Reduction in body temperature also increases the risk of infections; the investigators of this study reported that 46 % of cooled children developed an infection, compared with 39 % of the other children.Parent: So, the treatment is associated with some risk but can still improve the chances of my child surviving… how can you balance the benefits and the risks for my boy?Doctor: Honestly, I don’t know. If I just have to use numbers… 12 children would need to be cooled instead of kept at normal temperature in order to have one additional child with a good clinical outcome. And, 15 children would need to be cooled for one child to develop an infection.Parent: Please, try this treatment on my child.
Open Access 01.12.2015 | Editorial
Difficulty interpreting the results of some trials: the case of therapeutic hypothermia after pediatric cardiac arrest
Erschienen in: Critical Care | Ausgabe 1/2015