Hypothermia and hyperthermia in children after resuscitation from cardiac arrest

Objective. In experimental models of ischemic-anoxic brain injury, changes in body temperature after the insult have a profound influence on neurologi c outcome. Specifically, hypothermia ameliorates whereas hyperthermia exace rbates neurologic injury. Accordingly, we sought to determine the temperatu re changes occurring in children after resuscitation from cardiac arrest. Study Design. The clinical records of 13 children resuscitated from cardiac arrest were analyzed. Patients were identified through the emergency depar tment and pediatric intensive care unit arrest logs. Only patients survivin g for greater than or equal to 12 hours after resuscitation were considered for analysis. Charts were reviewed for body temperatures, warming or cooli ng interventions, antipyretic and antimicrobial administration, and evidenc e of infection. Results. Seven patients had a minimum temperature (T min) of less than or e qual to 35 degrees C and 11 had a maximum temperature (T max) of greater th an or equal to 38.1 degrees C. Hypothermia often preceded hyperthermia. All 7 patients with T min less than or equal to 35 degrees C were actively war med with heating lamps and 5 of 7 responded to warming with a rebound of bo dy temperatures greater than or equal to 38.1 degrees C. None of the 6 pati ents with T min >35 degrees C were actively warmed but all developed T max greater than or equal to 38.1 degrees C. Six patients received antipyretics and 11 received antibiotics. Fever was not associated with a positive cult ure in any case. Conclusion. Spontaneous hypothermia followed by hyperthermia is common afte r resuscitation from cardiac arrest. Temperature should be closely monitore d after cardiac arrest and fever should be managed expectantly.