Paediatric targeted temperature management post cardiac arrest: A systematic review and meta-analysis. (June 2019)

• Record Type: Journal Article
• 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
• Is Part Of: Resuscitation. Volume 139(2019)
• Page Start: 65
• Page End: 75
• Publication Date: 2019-06
• Subjects: Cardiac arrest -- Out-of-hospital cardiac arrest -- In hospital cardiac arrest -- Survival -- Long-term outcome -- Systematic review -- Meta-analysis -- Pediatrics; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.03.038
• Languages: English
• ISSNs: 0300-9572

Abstract

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.