Scholefield Barnaby, Duncan Heather, Davies Paul, Gao Smith Fang, Khan Khalid, Perkins Gavin D, Morris Kevin
Paediatric Intensive Care Unit, Birmingham Children’s Hospital, Birmingham, UK.
Cochrane Database Syst Rev. 2013 Feb 28;2013(2):CD009442. doi: 10.1002/14651858.CD009442.pub2.
Cardiopulmonary arrest in paediatric patients often results in death or survival with severe brain injury. Therapeutic hypothermia, lowering of the core body temperature to 32°C to 34°C, may reduce injury to the brain in the period after the circulation has been restored. This therapy has been effective in neonates with hypoxic ischaemic encephalopathy and adults after witnessed ventricular fibrillation cardiopulmonary arrest. The effect of therapeutic hypothermia after cardiopulmonary arrest in paediatric patients is unknown.
To assess the clinical effectiveness of therapeutic hypothermia after paediatric cardiopulmonary arrest.
We searched the Cochrane Anaesthesia Review Group Specialized Register; Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 11); Ovid MEDLINE (1966 to December 2011); Ovid EMBASE (1980 to December 2011); Ovid CINAHL (1982 to December 2011); Ovid BIOSIS (1923 to December 2011); and Web of Science (1945 to December 2011). We searched the trials registry databases for ongoing trials. We also contacted international experts in therapeutic hypothermia and paediatric critical care to locate further published and unpublished studies.
We planned to include randomized and quasi-randomized controlled trials comparing therapeutic hypothermia with normothermia or standard care in children, aged 24 hours to 18 years, after paediatric cardiopulmonary arrest.
Two authors independently assessed articles for inclusion.
We found no studies that satisfied the inclusion criteria. We found four on-going randomized controlled trials which may be available for analysis in the future. We excluded 18 non-randomized studies. Of these 18 non-randomized studies, three compared therapeutic hypothermia with standard therapy and demonstrated no difference in mortality or the proportion of children with a good neurological outcome; a narrative report was presented.
AUTHORS' CONCLUSIONS: Based on this review, we are unable to make any recommendations for clinical practice. Randomized controlled trials are needed and the results of on-going trials will be assessed when available.
儿科患者心脏骤停常导致死亡或存活但伴有严重脑损伤。治疗性低温，即将核心体温降至32°C至34°C，可能会减少循环恢复后时期内的脑损伤。这种疗法在患有缺氧缺血性脑病的新生儿以及目击室颤性心脏骤停后的成人中已证明有效。治疗性低温对儿科患者心脏骤停后的效果尚不清楚。
评估儿科心脏骤停后治疗性低温的临床疗效。
我们检索了Cochrane麻醉学综述小组专业注册库；Cochrane对照试验中心注册库（CENTRAL）（《Cochrane图书馆》2011年第11期）；Ovid MEDLINE（1966年至2011年12月）；Ovid EMBASE（1980年至2011年12月）；Ovid CINAHL（1982年至2011年12月）；Ovid BIOSIS（1923年至2011年12月）；以及科学引文索引（1945年至2011年12月）。我们检索了试验注册数据库以查找正在进行的试验。我们还联系了治疗性低温和儿科重症监护领域的国际专家，以查找更多已发表和未发表的研究。
我们计划纳入比较24小时至18岁儿童在儿科心脏骤停后治疗性低温与正常体温或标准治疗的随机和半随机对照试验。
两位作者独立评估文章是否符合纳入标准。
我们未找到符合纳入标准的研究。我们发现四项正在进行的随机对照试验，未来可能可供分析。我们排除了18项非随机研究。在这18项非随机研究中，三项比较了治疗性低温与标准治疗，结果显示死亡率或神经功能良好的儿童比例无差异；给出了一篇叙述性报告。
基于本综述，我们无法对临床实践提出任何建议。需要进行随机对照试验，正在进行的试验结果在可得时将予以评估。
