Temperature control after pediatric cardiac arrest: A Scoping Review of methods of delivery.

PICOST Short Title (edit) 4210.04 Temperature management after pediatric cardiac arrest – methods. Temperature control after pediatric cardiac arrest: A Scoping Review of methods of delivery. Research Question based on PCC (Population, Concept, Context) based on the Joanna Briggs Institute scoping review framework guidance. Population Pediatric patients (>24 hours to 18 years of age) with a sustained return of circulation after an in-hospital or out of hospital cardiac arrest. Concept Description of the available evidence, and published range of practice for a) time to initiation of active temperature target management, b) speed/rate of reaching temperature target, c) speed/rate of rewarming in patients actively controlled at hypothermic temperature, and d) methods of controlling temperature through the active temperature management process. Context Patients managed within a pre-hospital, or hospital environment, receiving protocolised active temperature management. * Active temperature control involves intentionally controlling a patient's body temperature to a specific temperature target range using a standardized management protocol. This includes all cooling/warming methods, temperature maintenance duration, pharmaco-therapy and monitoring strategies to achieve and sustain the desired target temperature. Search scope: Published data from 1966 to date in the Medline, EMBASE and Cochrane Register of Trials database. All studies references were screened. In conjunction with the team information specialist, two types of grey literature were identified as having potential to contribute to the search strategy. 1. Unpublished theses or dissertations fulfilling the PCC criteria. 2. Medical product evaluations of temperature management systems commissioned by government bodies. We devised the following search strategy: 1. Open Acces Theses and Dissertations (OATD), ProQuest Theses and Dissertations Global were searched for unpublished dissertations or theses. 2. The websites of the following organisations were searched using predefined key terms for medical product evaluations: NICE (UK), CADTH (Canada), MSAC (Australia), HAS (France), TLV (Sweden) The references of any resulting reports were checked for studies fulfilling the PCC criteria. 1. Review Team: *Lead Task Force Content Experts (1/2): Barney Scholefield, PICU, Canada, TF chair Mentees leading projects (non-ILCOR): 1. Idan Yoel – Paediatric Intensive Care Fellow, Sickkids / Israel 2. Thomas Main - Paediatric Intensive Care Fellow, Sickkids / UK *Lead Task Force Content Experts (2/2): 1. James Gray – Paed EM, USA 2. Arun Bansal - Paed Intensivist, India 3. Andrea Christoff – Paed/Cardiac Intensivist, Syndey Aus (ILCOR 4. Alexis Topjian, Paeds ICU, USA 5. Anne-Marie Guerguerian TF members Non-ILCOR working group member 1. Hari Krishnan – Paed Intensivist, Birmingham UK (external) 2. Olugbenga Akinkugbe - Canada 3. Marie Frazier - Paed Intensivist, USA (external) Indiana, USA 4. Jennifer Murphy – Pediatric Resuscitation Program Manager, Upstate Golisano Children’s Hospital, USA (external) 5. Jessie Cunningham (IS, Canada). SAC representative: Laurie Morrison – Toronto, Canada – Scientific Advisory Committee, ILCOR (Methodology expert/review) (assigned by SAC) Back up Content Experts (Optional) *Back up PICOST content expert: Alexis Topjian (preferably TF members*) Back Up Content Expert recommended for Lead and Nodal task forces but not mandated Back up Content Experts (1 per TF): (content experts who step in if a content expert becomes unable to complete the work. They are not on the team, nor eligible for authorship unless they are asked by TF chair to step into the role) *All review team members (including non-TF members) are expected to have completed the ILCOR COI documentation. TF chair or delegate will confirm COI through topic specific disclosures prior to assignment. ILCOR COI Policy and the COI Committee are resources to address any questions. • TF Chair attestation: I have checked for fiscal and intellectual conflict of interests and found none OR • I have checked for fiscal and intellectual conflict of interests; Author Scholefield (eg-has published THAPCA- in-hospital study in UK and is excluded from study selection and bias assessment). Topjian is co-investigator in P-ICECAP study. The following intellectual conflicts of interest have been declared. B Scholefield, A Guerguerian and A Topjian were co-investigator on the THAPCA-IH trial. A Topjian, H Krishnan, and A-M Guerguerian are co-investigators/site PIs in the P-ICECAP study. B Scholefield, A Topjian, H Krishan and A-M Guerguerian will be excluded from study selection. No members of the writing group have any financial conflicts of interest. 2. Pre-existing PICOs Related to the scope of work for this PICOST: This is a new Scoping Review. A related PICOST 4210.03 – is related to the Systematic Review of Temperature target and duration. 3. Definitions: (This should include definitions of all the relevant terms identified in the PICOST and in the body of literature related to this topic identified during task force discussion) ROC: Return of spontaneous circulation or support by ECMO with sustained ROC, defined as lasting more than 20 minutes. Active temperature control- active control of temperature, requiring continuous temperature monitoring and temperature controlling devices, and or active pharmacological and non-pharmacological measures. Hypothermic temperature control - active temperature control with the target temperature below the normal range. Normothermic temperature control- active temperature control with the target temperature in the normal range. Fever prevention temperature control- active temperature control with a target temperature in a normal range by preventing fever. No temperature control- no protocolized active temperature control strategy. Out-of-hospital cardiac arrest (OHCA)- sudden cessation of cardiac activity resulting in unresponsiveness, absent or abnormal breathing, and lack of circulation, occurring outside a hospital setting. In-hospital cardiac Arrest (IHCA) is a sudden cessation of cardiac activity resulting in unresponsiveness, absent or abnormal breathing, and lack of circulation within a hospital setting. Extracorporeal Membrane Oxygenation (ECMO) - a life-support technique that uses an external machine to provide cardiac and/or respiratory support by oxygenating blood and removing carbon dioxide outside the body. Extracorporeal Cardiopulmonary Resuscitation (ECPR) - an advanced resuscitation technique that uses extracorporeal membrane oxygenation (ECMO) to provide temporary cardiac and respiratory support in patients with cardiac arrest who are unresponsive to conventional CPR. Good neurological outcome- the recovery of brain function to a level that allows independence in daily activities and minimal cognitive or functional impairment, will be measured using standardized scales like Cerebral Performance Category (CPC) (1-2), Pediatric Cerebral Performance Category (PCPC) (1-2), Modified Rankin Scale (mRS) (0-2) or Glasgow Outcome Scale (GOS) (4-5). 4. Background and Rationale for this PICOST: This section feeds directly into the introduction of the manuscript or speaks to the importance of the scope of work (Evidence Update) (Why is this review important to complete now and what are the potential clinical implications of completing this review? Include how this new science is anticipated to impact on the existing ILCOR recommendations. References required as per ILCOR format embedded in text (last name first author, year of publication, first page number and list full references at bottom of form). In children that survive an out-of-hospital cardiac arrest, neurodisability secondary to hypoxic brain injury is the primary cause of morbidity. Neurologic injury is also common in children that survive in-hospital cardiac arrest, although they are more likely to have additional co-morbidity (1). Brain injury is caused by ischaemia during the initial hypoxic period, as well as secondary injury during the post cardiac arrest syndrome. Post-resuscitation care aims to modify injury during post-cardiac arrest syndrome through a set of management strategies to reduce inflammation through the maintenance of particular homeostatic targets, promotion of venous drainage, and the reduction of metabolic activity. One of these is active temperature management using continuous temperature monitoring and control through a variety of methods. There is evidence in the paediatric population that persistent fever during the post arrest period is associated with a worse neurological outcome(2), targeted temperature management to either hypothermia or normothermia is accepted as a standard of care(3), however the evidence base for superiority of one over the other is equivocal, and there are centers that utilize both approaches. In terms of how to deliver active temperature control in the paediatric population, there is an evolving evidence base including systematic reviews for target temperature, and active temperature control duration(4–6), however not for other key aspects of protocol delivery. A 2021 systematic review of the adult literature reviewed target temperature, active temperature control duration, as well as time to initiation, rate of rewarming, and method of temperature control(7). The International Committee on Resuscitation (ILCOR) Advanced Life Support (ALS) Task Force (TF) included these in a Consensus on Science with Treatments review on temperature control in adult cardiac arrest(8). However, the same does not exist in the paediatric literature as there are no RCTs addressing these aspects of delivery. The adult consensus guidance cannot be generalized to the paediatric population in view of differing aetiology of preceding cardiac arrest, physiology and response to temperature management (e.g. patient

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