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
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Article info
Publication history
Published online: April 02, 2019
Accepted:
March 20,
2019
Received in revised form:
March 20,
2019
Received:
February 12,
2019
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
