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

RESUSCITATION

卷:139

Review

Buick, Jason E.¹  Wallner, Clare²  Aickin, Richard³  Meaney, Peter A.⁴  de Caen, Allan^5,6  Maconochie, Ian⁷  Skifvars, Markus B.^8,9  Welsford, Michelle² 

[1] Univ Toronto, Inst Hlth Policy Management & Evaluat, 155 Coll St Room 425, Toronto, ON M5R 3M6, Canada

[2] McMaster Univ, Hamilton Gen Hosp, Div Emergency Med, 237 Barton St E,Room 253, Hamilton, ON L8L 2X2, Canada

[3] Univ Auckland, Auckland Hosp, Dept Paediat & Child Hlth, Bldg 599,2 Pk Rd Level 12, Auckland 1023, New Zealand

[4] Stanford Univ, Div Pediat Crit Care, 770 Welch Rd Room 435, Palo Alto, CA 94304 USA

[5] Univ Alberta, Stollery Childrens Hosp, Pediat Crit Care Med, 11405 87th Ave, Edmonton, AB T6G 1C9, Canada

[6] Univ Alberta, Dept Pediat, 11405 87th Ave, Edmonton, AB T6G 1C9, Canada

[7] Imperial Coll, Imperial Coll NHS Healthcare Trust, Paediat Emergency Med Dept, London W2 1NY, England

[8] Univ Helsinki, Dept Emergency Care & Serv, Helsinki, Finland

[9] Helsinki Univ Hosp, Helsinki, Finland

关键词: Cardiac arrest;    Out-of-hospital cardiac arrest;    In hospital cardiac arrest;    Survival;    Long-term outcome;    Systematic review;    Meta-analysis;    Pediatrics;   

DOI  :  10.1016/j.resuscitation.2019.03.038

来源: Elsevier

【 摘 要 】

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.

【 授权许可】

Free