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The use of mild hypothermia after OHCA due to VF in adults has been associated
with improved neurologic outcome and is generally tolerated without any
significant complication. Current AHA recommendations are to begin targeted
temperature management with a consistent goal of between 32° and 36°C for all
adult patients after arrest who remain comatose, regardless of presenting rhythm
or location of arrest (though recommended in those patients with initial shockable
rhythm from OHCA and suggested for all other populations). Data from large,
multicenter, randomized controlled trials have demonstrated that therapeutic
hypothermia for asphyxiated newly born infants ≥36 weeks’ gestation can reduce
death and neurologic disability when initiated within 6 hours of birth. AHA
guidelines recommend that all such infants with moderate to severe hypoxicischemic encephalopathy be offered therapeutic hypothermia.
However, the data for pediatric patients is less clear. Recent large, randomizedcontrolled trials of targeted temperature management found no difference in
neurologic outcome between hypothermia (32° to 34°C) and normothermia (36°
to 37.5°C). Current AHA guidelines state that either targeted temperature
management to normothermia (36° to 37.5°C) for 5 days, or hypothermia (32° to
34°C) for 2 days followed by 3 days of normothermia may be considered for
children who remain comatose after return of spontaneous circulation following
cardiac arrest. Fever adversely affects recovery from ischemic brain injury, and
should be treated aggressively; avoiding temperatures of 38°C or higher is
recommended.

QUALITY IMPROVEMENT
EDs represent a high-risk environment for the medical care of patients due to
factors such as clinical uncertainty, frequent interruptions, and the need for haste.
Children are at particular risk in emergency care because of their physical and
developmental vulnerabilities, their inability to accurately describe symptoms or
past medical history, the complexity of weight-based treatment, and the relative
discomfort of some providers in treating pediatric patients. This risk is
particularly heightened during emergency resuscitation, which is a teamdependent and information-intensive process of rapidly treating acute life- and
organ-threatening diseases. The medical resuscitation environment is especially
prone to medical errors due to its fast-paced, complex environment. Therefore,

ongoing surveillance of resuscitation events is vital; with an eye toward process
and system changes which can support the resuscitation team, minimize
distraction from patient care and maximize protocol adherence. A video review
process in which all resuscitation events are video-recorded, and a subset is