Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis.
Resuscitation
; 139: 65-75, 2019 06.
Article
in En
| MEDLINE
| ID: mdl-30951842
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.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Hypoxia-Ischemia, Brain
/
Neurodevelopmental Disorders
/
Heart Arrest
/
Hypothermia, Induced
Type of study:
Clinical_trials
/
Etiology_studies
/
Systematic_reviews
Limits:
Child
/
Humans
Language:
En
Journal:
Resuscitation
Year:
2019
Document type:
Article