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

(2019) RESUSCITATION. 139. p.65-75
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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.
Keywords
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

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Citation

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MLA
Buick, JE, et al. “Paediatric Targeted Temperature Management Post Cardiac Arrest : A Systematic Review and Meta-Analysis.” RESUSCITATION, vol. 139, 2019, pp. 65–75.
APA
Buick, J., Wallner, C., Aickin, R., Meaney, P., de Caen, A., Maconochie, I., … Van de Voorde, P. (2019). Paediatric targeted temperature management post cardiac arrest : a systematic review and meta-analysis. RESUSCITATION, 139, 65–75.
Chicago author-date
Buick, JE, C Wallner, R Aickin, PA Meaney, A de Caen, I Maconochie, MB Skrifvars, et al. 2019. “Paediatric Targeted Temperature Management Post Cardiac Arrest : A Systematic Review and Meta-Analysis.” RESUSCITATION 139: 65–75.
Chicago author-date (all authors)
Buick, JE, C Wallner, R Aickin, PA Meaney, A de Caen, I Maconochie, MB Skrifvars, M Welsford, D. Atkins, R. Bingham, TB Bittencourt, A. Guerguerian, MF Hazinski, E. Layonas, V. Nadkarni, K. Ng, G. Nuthall, S. Ohshimo, Yong-Kwang Gene Ong, A. Reis, S. Schexnayder, B. Scholefield, N. Shimizu, J. Tijssen, and Patrick Van de Voorde. 2019. “Paediatric Targeted Temperature Management Post Cardiac Arrest : A Systematic Review and Meta-Analysis.” RESUSCITATION 139: 65–75.
Vancouver
1.
Buick J, Wallner C, Aickin R, Meaney P, de Caen A, Maconochie I, et al. Paediatric targeted temperature management post cardiac arrest : a systematic review and meta-analysis. RESUSCITATION. 2019;139:65–75.
IEEE
[1]
J. Buick et al., “Paediatric targeted temperature management post cardiac arrest : a systematic review and meta-analysis,” RESUSCITATION, vol. 139, pp. 65–75, 2019.
@article{8649310,
  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.},
  author       = {Buick, JE and Wallner, C and Aickin, R and Meaney, PA and de Caen, A and Maconochie, I and Skrifvars, MB and Welsford, M and Atkins, D. and Bingham, R. and Bittencourt, TB and Guerguerian, A. and Hazinski, MF and Layonas, E. and Nadkarni, V. and Ng, K. and Nuthall, G. and Ohshimo, S. and Ong, Yong-Kwang Gene and Reis, A. and Schexnayder, S. and Scholefield, B. and Shimizu, N. and Tijssen, J. and Van de Voorde, Patrick},
  issn         = {0300-9572},
  journal      = {RESUSCITATION},
  keywords     = {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},
  language     = {eng},
  pages        = {65--75},
  title        = {Paediatric targeted temperature management post cardiac arrest : a systematic review and meta-analysis},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2019.03.038},
  volume       = {139},
  year         = {2019},
}

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