Paediatric targeted temperature management post cardiac arrest : A systematic review and meta-analysis

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Int Liaison Comm Resuscitation , Buick , J E , Wallner , C , Aickin , R , Meaney , P A , de Caen , A , Maconochie , I , Skrifvars , M B & Welsford , M 2019 , ' Paediatric targeted temperature management post cardiac arrest : A systematic review and meta-analysis ' , Resuscitation , vol. 139 , pp. 65-75 . https://doi.org/10.1016/j.resuscitation.2019.03.038

Title: Paediatric targeted temperature management post cardiac arrest : A systematic review and meta-analysis
Author: Int Liaison Comm Resuscitation; Buick, Jason E.; Wallner, Clare; Aickin, Richard; Meaney, Peter A.; de Caen, Allan; Maconochie, Ian; Skrifvars, Markus B.; Welsford, Michelle
Contributor organization: HUS Emergency Medicine and Services
Department of Diagnostics and Therapeutics
Date: 2019-06
Language: eng
Number of pages: 11
Belongs to series: Resuscitation
ISSN: 0300-9572
DOI: https://doi.org/10.1016/j.resuscitation.2019.03.038
URI: http://hdl.handle.net/10138/314178
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 degrees 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 degrees C compared with a target at 36-37.5 degrees 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 degrees 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 degrees 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.
Subject: Cardiac arrest
Out-of-hospital cardiac arrest
In hospital cardiac arrest
Survival
Long-term outcome
Systematic review
Meta-analysis
Pediatrics
ADVANCED LIFE-SUPPORT
CARDIOVASCULAR CARE SCIENCE
AMERICAN-HEART-ASSOCIATION
THERAPEUTIC HYPOTHERMIA
CARDIOPULMONARY-RESUSCITATION
INTERNATIONAL CONSENSUS
OUTCOMES
GUIDELINES
EXPERIENCE
SURVIVAL
3126 Surgery, anesthesiology, intensive care, radiology
Peer reviewed: Yes
Rights: cc_by_nc_nd
Usage restriction: openAccess
Self-archived version: acceptedVersion


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