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Resuscitation. 2019 Apr 2. pii: S0300-9572(19)30107-8. doi: 10.1016/j.resuscitation.2019.03.038. [Epub ahead of print]

Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis.

Author information

1
Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street - Room 425, Toronto, ON M5R 3M6, Canada. Electronic address: jason.buick@mail.utoronto.ca.
2
Division of Emergency Medicine, McMaster University, Hamilton General Hospital, 237 Barton St E., Room 253, Hamilton, ON L8L 2X2, Canada. Electronic address: wallnerc@mcmaster.ca.
3
Department of Paediatrics and Child Health, University of Auckland, Auckland Hospital - Building 599, 2 Park Road - Level 12, Auckland 1023, New Zealand. Electronic address: RichardA@adhb.govt.nz.
4
Division of Pediatric Critical Care, Stanford University, 770 Welch Road - Room 435, Palo Alto, California 94304, United States. Electronic address: meaneypa@stanford.edu.
5
Pediatric Critical Care Medicine, Stollery Children's Hospital & Department of Pediatrics, University of Alberta, 11405 - 87th Avenue, Edmonton, Alberta T6G 1C9, Canada. Electronic address: Allan.DeCaen@albertahealthservices.ca.
6
Paediatric Emergency Medicine Department, Imperial College NHS Healthcare Trust, Imperial College, London W2 1NY, United Kingdom. Electronic address: i.maconochie@imperial.ac.uk.
7
Department of Emergency Care and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland. Electronic address: Markus.Skrifvars@hus.fi.
8
Division of Emergency Medicine, McMaster University, Hamilton General Hospital, 237 Barton St E., Room 253, Hamilton, ON L8L 2X2, Canada. Electronic address: welsford@mcmaster.ca.

Abstract

INTRODUCTION:

The International Liaison Committee on Resuscitation prioritized the need to update the review on the use of targeted temperature management (TTM) in paediatric post cardiac arrest care. In this meta-analysis, the effectiveness of TTM at 32-36 °C was compared with no target or a different target for comatose children who achieve a return of sustained circulation after cardiac arrest.

METHODS:

Electronic databases were searched from inception to December 13, 2018. Randomized controlled trials and non-randomized studies with a comparator group that evaluated TTM in children were included. Pairs of independent reviewers extracted the demographic and outcome data, appraised risk of bias, and assessed GRADE certainty of effects. A random effects meta-analysis was undertaken where possible.

RESULTS:

Twelve studies involving 2060 patients were included. Two randomized controlled trials provided the evidence that TTM at 32-34 °C compared with a target at 36-37.5 °C did not statistically improve long-term good neurobehavioural survival (risk ratio: 1.15; 95% CI: 0.69-1.93), long-term survival (RR: 1.14; 95% CI: 0.93-1.39), or short-term survival (risk ratio: 1.14; 95% CI: 0.96-1.36). TTM at 32-34 °C did not show statistically increased risks of infection, recurrent cardiac arrest, serious bleeding, or arrhythmias. A novel analysis suggests that another small RCT might provide enough evidence to show benefit for TTM in out-of-hospital cardiac arrest.

CONCLUSION:

There is currently inconclusive evidence to either support or refute the use of TTM at 32-34 °C for comatose children who achieve return of sustained circulation after cardiac arrest. Future trials should focus on children with out-of-hospital cardiac arrest.

KEYWORDS:

Cardiac arrest; In hospital cardiac arrest; Long-term outcome; Meta-analysis; Out-of-hospital cardiac arrest; Survival; Systematic review

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