Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis Academic Article uri icon

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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.

authors

  • Buick, Jason E
  • Wallner, Clare
  • Aickin, Richard
  • Meaney, Peter A
  • de Caen, Allan
  • Maconochie, Ian
  • Skifvars, Markus B
  • Welsford, Michelle
  • Meaney, Peter
  • Aickin, Richard
  • de Caen, Allan
  • Maconochie, Ian
  • Atkins, Dianne
  • Bingham, Robert
  • Couto, Thomaz Bittencourt
  • Guerguerian, Anne-Marie
  • Hazinski, Mary Fran
  • Layonas, Eric
  • Nadkarni, Vinay
  • Ng, Kee-Chong
  • Nuthall, Gabrielle
  • Ohshimo, Shinichiro
  • Ong, Yong-Kwang Gene
  • Reis, Amelia
  • Schexnayder, Steve
  • Scholefield, Barney
  • Shimizu, Naoki
  • Tijssen, Janice
  • Van de Voorde, Patrick

publication date

  • June 2019