Abstract
Cardiac arrest (CA) is associated with high mortality and poor life quality. Targeted temperature management (TTM) or therapeutic hypothermia is a therapy increasing the survival of adult patients after CA. The study aim was to assess the feasibility of therapeutic hypothermia after pediatric CA. We performed a systematic review and meta-analysis of randomized controlled trials and observational studies evaluating the use of TTM after pediatric CA. The primary outcome was survival to hospital discharge or 30-day survival. Secondary outcomes included a one-year survival rate, survival with a Vineland adaptive behavior scale (VABS-II) score ≥ 70, and occurrence of adverse events. Ten articles (n = 2002 patients) were included, comparing TTM patients (n = 638) with controls (n = 1364). In a fixed-effects meta-analysis, survival to hospital discharge in the TTM group was 49.7%, which was higher than in the non-TTM group (43.5%; odds ratio, OR = 1.22; 95% confidence interval, CI: 1.00, 1.50; p = 0.06). There were no differences in the one-year survival rate or the occurrence of adverse events between the TTM and non-TTM groups. Altogether, the use of TTM was associated with a higher survival to hospital discharge; however, it did not significantly increase the annual survival. Additional high-quality prospective studies are necessary to confer additional TTM benefits.
Highlights
We looked for a potential publication bias by using a funnel plot if more than 10 trials were included for an outcome
The sub-analysis showed that the survival to hospital discharge or 30-day survival rate was higher in the temperature management (TTM) compared with the non-TTM group for of-hospital CA (OHCA) (42.5% vs. 39.7%; odds ratio (OR) = 1.25; 95% CI: 0.96, 1.63; p = 0.09; I2 = 0%), as well as for in-hospital cardiac arrest (IHCA) (59.7% vs. 57.5%; OR = 0.94; 95% CI: 0.47, 1.91; p = 0.87; I2 = 53%)
On the primary outcome, i.e., 30-day survival, but not on any other studied endpoint. This meta-analysis did not demonstrate any significant increase in the annual survival or neurological status
Summary
For out-of-hospital CA (OHCA), survival to hospital discharge rates range from 2 to 27% [1,2,3]. Even fewer victims survive in a good neurological status (approximately 24–50% of the survivors [1,2]), with the rest experiencing long-term physical and psychological burdens, adversely affecting the quality of life [1,2]. This highly unsatisfactory outcome has pushed professionals to seek new treatments and refine the existing protocols in the hope for an improvement. Much effort has been made globally to research these treatments and refine them with various techniques to achieve the goal [4]
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