What is the general approach to temperature management after pediatric ROSC?

• A. Avoid hyperthermia; maintain normothermia; consider targeted temperature management per protocol
• B. Induce hypothermia below 32 C immediately
• C. Let fever run its course
• D. Ignore temperature management

Answer: (A)

After pediatric ROSC, protecting the brain from temperature-related injury is the main goal. Fever after resuscitation is common and is linked to worse neurological outcomes, so the priority is to avoid hyperthermia and keep the child within a normal temperature range. Implementing targeted temperature management per protocol allows clinicians to control temperature when appropriate, aiming for a safe range rather than assuming deep cooling is always beneficial. Deep cooling below 32°C carries risks—such as arrhythmias, bleeding, infection, and the need for intensive monitoring—and the pediatric data do not support routine immediate deep hypothermia for all patients. Keeping temperature managed through normothermia and protocol-directed cooling when indicated addresses the brain injury risk while minimizing unnecessary harm. Letting fever run unchecked or ignoring temperature management would miss the opportunity to limit secondary brain injury after ROSC.