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 neurologic outcome. Specifically, hypothermia ameliorates whereas hyperthermia exacerbates neurologic injury. Accordingly, we sought to determine the temperature 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 department and pediatric intensive care unit arrest logs. Only patients surviving for greater than or equal to 12 hours after resuscitation were considered for analysis. Charts were reviewed for body temperatures, warming or cooling interventions, antipyretic and antimicrobial administration, and evidence of infection. Results. Seven patients had a minimum temperature (T min) of less than or equal to 35 degrees C and 11 had a maximum temperature (T max) of greater than 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 warmed with heating lamps and 5 of 7 responded to warming with a rebound of body temperatures greater than or equal to 38.1 degrees C. None of the 6 patients 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 culture in any case. Conclusion. Spontaneous hypothermia followed by hyperthermia is common after resuscitation from cardiac arrest. Temperature should be closely monitored after cardiac arrest and fever should be managed expectantly.