Individualized Treatment Effects of Therapeutic Hypothermia in Children Postcardiac Arrest: A Reanalysis of Two Randomized Clinical Trials

Q: What does this research mean for the field?

Heterogeneity of treatment effect exists in pediatric post-cardiac arrest temperature management, with specific patient subgroups experiencing distinct survival and neurobehavioral benefits or harms from therapeutic hypothermia compared to normothermia. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Daniel Balcarcel; Garrett Keim; Sanjiv Mehta; Michael O. Harhay; Blanca E. Himes; Wouter A. C. van Amsterdam; Frank Moler; Matthew P. Kirschen; Alexis A. Topjian; Nadir Yehya

doi:10.1097/pcc.0000000000004010

July 1, 2026Pediatric Critical Care Medicine

Individualized Treatment Effects of Therapeutic Hypothermia in Children Postcardiac Arrest: A Reanalysis of Two Randomized Clinical Trials

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Key Points

To estimate individualized treatment effects of hypothermia versus normothermia in pediatric cardiac arrest patients.
Secondary analysis of two randomized controlled trials (THAPCA-OH and THAPCA-IH)
Used causal forest machine learning model to estimate individualized treatment effects
Included pediatric patients aged 48 hours to 18 years with specific eligibility criteria
In THAPCA-OH, the tertile with the greatest benefit from hypothermia showed an absolute risk difference (ARD) of 0.18 (95% CI, 0.02-0.34)
In THAPCA-IH, the tertile with the greatest benefit from hypothermia had an ARD of 0.27 (95% CI, 0.07-0.48)
The adverse prognostic tertile estimated for normothermia showed an ARD of -0.20 (95% CI, -0.40 to -0.01)

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Implication

Randomized trial estimates individualized treatment effects in children after cardiac arrest, suggesting varied benefits of hypothermia.

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Cite This Study

Balcarcel et al. (2026) studied this question.

synapsesocial.com/papers/6a4753435c29257aa25797e1 https://doi.org/10.1097/pcc.0000000000004010

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Individualized Treatment Effects of Therapeutic Hypothermia in Children Postcardiac Arrest: A Reanalysis of Two Randomized Clinical Trials

Key Points

No abstract yet

Implication

Discussion

Cite This Study

Individualized Treatment Effects of Therapeutic Hypothermia in Children Postcardiac Arrest: A Reanalysis of Two Randomized Clinical Trials

Key Points

No abstract yet

Implication

Discussion

Cite This Study

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