Targeted Temperature Management Strategies in Pediatric Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Grading of Recommendations, Assessment, Development, and Evaluation-Assessed Systematic Review and Meta-Analysis.
Mohammed Alsabri, Shree Rath, Ibrahim Kamal et al.
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In 30 seconds
This GRADE-assessed systematic review and meta-analysis evaluated targeted temperature management after out-of-hospital cardiac arrest in children, including nine studies and 2107 patients. Compared with normothermia, therapeutic hypothermia was associated with higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18; p < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; p = 0.006). Subgroup analyses suggested benefits at longer follow-up. Most outcome evidence was graded low certainty, largely because studies were predominantly nonrandomized and estimates were imprecise.
Key findings
- Therapeutic hypothermia was associated with higher survival odds than normothermia (OR: 1.72; 95% CI: 1.36-2.18; p < 0.0001).
- Favorable neurological outcome was more likely with therapeutic hypothermia (OR: 1.64; 95% CI: 1.16-2.33; p = 0.006).
- Subgroup analyses found greater survival benefit at 12 months and improved neurological outcomes at 6-12 months.
- No statistically significant group differences were found in lactate, arrhythmia, culture-proven infection, or hospital stay.
Why it matters
Neurological injury and survival are major concerns after pediatric out-of-hospital cardiac arrest. The pooled findings suggest that therapeutic hypothermia may be associated with better survival and neurological outcomes than normothermia, while the review found no significant differences in several reported adverse outcomes. However, low-certainty evidence means these estimates should be interpreted cautiously.
What to keep in mind
Most included studies were nonrandomized, and the certainty of evidence for most outcomes was low because of imprecision.