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Therapeutic Hypothermia to Improve Survival After Cardiac Arrest in Pediatric Patients-THAPCA-IH [In Hospital] Trial (THAPCA-IH)

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ClinicalTrials.gov Identifier: NCT00880087
Recruitment Status : Completed
First Posted : April 13, 2009
Last Update Posted : May 13, 2016
Information provided by (Responsible Party):

Study Description
Brief Summary:
Cardiac arrest is a sudden, unexpected loss of heart function. Therapeutic hypothermia, in which the body's temperature is lowered and maintained several degrees below normal for a period of time, has been used to successfully treat adults who have experienced cardiac arrest. This study will evaluate the efficacy of therapeutic hypothermia at increasing survival rates and reducing the risk of brain injury in infants and children who experience a cardiac arrest while in the hospital.

Condition or disease Intervention/treatment Phase
Cardiac Arrest Procedure: Therapeutic Hypothermia Procedure: Therapeutic Normothermia Phase 3

Detailed Description:

Cardiac arrest occurs when the heart suddenly stops beating and blood flow to the body is halted. It can occur while people are in the hospital because of a medical condition or while people are out of the hospital as a result of an accident or other cause. Cardiac arrest is a serious event that is associated with high rates of death and long-term disability. When a person experiences cardiac arrest,insufficient amount of blood flow and oxygen can result in brain injury.

Therapeutic hypothermia is a therapy that involves a controlled lowering of the body temperature and then maintenance of this lower temperature for a period of time. Therapeutic hypothermia has been successfully used in adults who experience cardiac arrest to improve survival rates and health outcomes, and it has also been studied in newborn infants who have suffered from perinatal asphyxia. The purpose of this study is to evaluate the efficacy of therapeutic hypothermia at improving survival rates and reducing brain injury in infants and children who experience cardiac arrest while in the hospital.

Study researchers will conduct this study in collaboration with the following two pediatric clinical research networks: the Pediatric Emergency Care Applied Research Network (PECARN), funded by the Emergency Medical Services for Children (EMSC) program, and the National Institute of Child Health and Human Development (NICHD) Collaborative Pediatric Critical Care Research Network (CPCCRN).

The study will enroll infants and children who have suffered a cardiac arrest while in the hospital. Randomization must occur within 6 hours of return of spontaneous circulation. Participants will be randomly assigned to receive either therapeutic hypothermia or therapeutic normothermia. Participants receiving therapeutic hypothermia will have their body temperature reduced to between 32° and 34° Celsius (C) and will remain at this temperature for 2 days. Their body temperature will then be slowly increased to the normal temperature of 36° to 37.5° C, which will be maintained until 5 days after the cardiac arrest. Participants receiving therapeutic normothermia will have their normal temperature maintained between 36° and 37.5° C for 5 days after the cardiac arrest. Special temperature control blankets will be placed to maintain their body temperature in the assigned range. After 5 days, each participant's temperature will be managed by their medical care team.

While participants are in the hospital, they will undergo frequent blood and urine collections, chest x-rays, and temperature measurements; parents of participants will complete questionnaires. When participants are ready to leave the hospital, study researchers will perform a physical and functional assessment. Twenty-eight days after the cardiac arrest, researchers will contact parents of participants to gather information on the participants' health and medical condition. At Months 3 and 12, a child development expert will contact parents to gather medical information. At Month 12, participants will attend a study visit for a neurologic examination and testing with a psychologist trained in rehabilitation.

Study Design

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 329 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Therapeutic Hypothermia After Pediatric Cardiac Arrest (In Hospital)
Study Start Date : September 2009
Primary Completion Date : February 2016
Study Completion Date : February 2016

Resource links provided by the National Library of Medicine

U.S. FDA Resources

Arms and Interventions

Arm Intervention/treatment
Experimental: Therapeutic Hypothermia
Participants will receive therapeutic hypothermia after experiencing cardiac arrest.
Procedure: Therapeutic Hypothermia
Participants who are assigned to receive therapeutic hypothermia will be cooled to a target temperature of 33º C plus or minus 1º C (32° to 34º C). This temperature will be maintained for 48 hours (2 days) and then participants will be warmed to a target temperature of 36.75º C plus or minus 0.75º C (36° to 37.5º C). This temperature will be maintained until 120 hours (5 days) after the cardiac arrest.
Active Comparator: Therapeutic Normothermia
Participants will receive therapeutic normothermia after experiencing cardiac arrest.
Procedure: Therapeutic Normothermia
Participants who are assigned to receive therapeutic normothermia will have their temperature maintained at 36.75º C plus or minus 0.75º C (36° to 37.5º C) for 120 hours (5 days) after the cardiac arrest.

Outcome Measures

Primary Outcome Measures :
  1. Survival with good neurobehavioral outcome [ Time Frame: Measured at Month 12 ]

Secondary Outcome Measures :
  1. Survival [ Time Frame: Measured at Month 12 ]
  2. Change in neurobehavioral function from pre-cardiac arrest to 12 months post-cardiac arrest [ Time Frame: Measured at Month 12 ]
  3. Neuropsychological scores (for participants who survive) [ Time Frame: Measured at Month 12 ]
  4. Neurological abnormality scores (for participants who survive) [ Time Frame: Measured at Month 12 ]

Eligibility Criteria

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Ages Eligible for Study:   up to 18 Years   (Child, Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No

Inclusion Criteria:

  • Patient suffered cardiac arrest requiring chest compressions for at least 2 minutes (120 seconds) with ROSC/ROC; AND
  • Age greater than 48 hours (with a corrected gestational age of at least 38 weeks) and less than 18 years; AND
  • Patient requires continuous mechanical ventilation; AND
  • The cardiac arrest was unplanned (i.e., not part of cardiac surgical procedure)

Exclusion Criteria:

  • The parent or legal guardian does not speak English or Spanish (the only two languages in which VABS II is standardized)
  • Randomization is impossible within six hours of ROSC; OR
  • Patient is on extracorporeal membrane oxygenation (ECMO) when arrest occurs; OR
  • Continuous infusion of epinephrine or norepinephrine at very high doses (≥2 ug/kg/minute) received immediately prior to randomization; OR Glasgow Coma Scale motor response of five (localizing pain or for infants less than two years, withdraws to touch) or six (obeys commands, or for infants, normal spontaneous movement) prior to randomization; OR
  • History of a prior cardiac arrest with chest compressions for at least two minutes during the current hospitalization but outside the 6 hour window for randomization; OR
  • Pre-existing terminal illness with life expectancy < 12 months; OR
  • Lack of commitment to aggressive intensive care therapies including do not resuscitate orders and other limitations to care; OR
  • Cardiac arrest was associated with severe brain, thoracic, or abdominal trauma; OR
  • Active and refractory severe bleeding prior to randomization; OR
  • Near drowning in ice water with patient core temperature ≤32 °C on presentation; OR
  • Patient is pregnant; OR
  • Patient participation in a concurrent interventional trial whose protocol, in the judgment of the THAPCA investigators, prevents effective application of one or both THAPCA therapeutic treatment arms, or otherwise significantly interferes with carrying out the THAPCA protocol; OR
  • Patient is newborn with acute birth asphyxia; OR

    _ Patient cared for in a neonatal intensive care unit (NICU) after arrest (ie, would not be admitted to PICU); OR

  • Patient has sickle cell anemia; OR
  • Patient known to have pre-existing cryoglobulinemia; OR
  • Central nervous system tumor with ongoing chemotherapy or radiation therapy; OR
  • Chronic hypothermia secondary to hypovolemic, pituitary, or related condition for which body temperature is consistently below 37 °C ; OR progressive degenerative encephalopathy; OR
  • Any condition in which direct skin surface cooling would be contraindicated, such as large burns, decubitus ulcers, cellulitis, or other conditions with disrupted skin integrity (NOTE: patients with open chest CPR should be included but placement of cooling mattresses will be modified as needed); OR
  • Previous enrollment in the THAPCA Trials.
Contacts and Locations

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT00880087

  Show 33 Study Locations
Sponsors and Collaborators
University of Michigan
National Heart, Lung, and Blood Institute (NHLBI)
Principal Investigator: Frank Moler, MD University of Michigan
Principal Investigator: Michael Dean, MD University of Utah
More Information

Publications automatically indexed to this study by ClinicalTrials.gov Identifier (NCT Number):

Responsible Party: Frank W. Moler, M.D, M.S, Professor of Pediatrics, University of Michigan
ClinicalTrials.gov Identifier: NCT00880087     History of Changes
Other Study ID Numbers: 620
U01HL094345 ( U.S. NIH Grant/Contract )
First Posted: April 13, 2009    Key Record Dates
Last Update Posted: May 13, 2016
Last Verified: May 2016

Keywords provided by Frank W. Moler, M.D, M.S, University of Michigan:
Cardiac Arrest
Cardiopulmonary Arrest
Pediatric Cardiac Arrest
Vineland Adaptive Behavior Scale
hypoxic-ischemic encephalopathy

Additional relevant MeSH terms:
Heart Arrest
Heart Diseases
Cardiovascular Diseases
Body Temperature Changes
Signs and Symptoms