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.
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.
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.
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.
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Published online: April 02, 2019
Accepted: March 20, 2019
Received in revised form: March 20, 2019
Received: February 12, 2019
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