Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street - Room 425, Toronto, ON M5R 3M6, Canada.
Division of Emergency Medicine, McMaster University, Hamilton General Hospital, 237 Barton St E., Room 253, Hamilton, ON L8L 2X2, Canada.
Resuscitation. 2019 Jun;139:65-75. doi: 10.1016/j.resuscitation.2019.03.038. Epub 2019 Apr 2.
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 °C was compared with no target or a different target for comatose children who achieve a return of sustained circulation after cardiac arrest.
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.
Twelve studies involving 2060 patients were included. Two randomized controlled trials provided the evidence that TTM at 32-34 °C compared with a target at 36-37.5 °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 °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.
There is currently inconclusive evidence to either support or refute the use of TTM at 32-34 °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.
复苏国际联络委员会优先考虑更新关于儿科心脏骤停后护理中目标温度管理（TTM）使用的综述。在这项荟萃分析中，将 32-36°C 的 TTM 与无目标或不同目标的昏迷儿童进行比较，这些儿童在心脏骤停后恢复持续循环。
从开始到 2018 年 12 月 13 日，电子数据库进行了搜索。纳入了评估儿童 TTM 的随机对照试验和非随机研究，并设有对照组。由两名独立的审查员提取人口统计学和结果数据，评估偏倚风险，并评估 GRADE 效应确定性。在可能的情况下进行了随机效应荟萃分析。
纳入了 12 项涉及 2060 名患者的研究。两项随机对照试验提供的证据表明，与 36-37.5°C 的目标相比，32-34°C 的 TTM 并没有在统计学上改善长期良好的神经行为生存（风险比：1.15；95%CI：0.69-1.93）、长期生存（RR：1.14；95%CI：0.93-1.39）或短期生存（风险比：1.14；95%CI：0.96-1.36）。32-34°C 的 TTM 并未显示出感染、复发性心脏骤停、严重出血或心律失常的风险增加。一项新的分析表明，另一项小型 RCT 可能提供足够的证据表明 TTM 在院外心脏骤停中有益。
目前尚无确凿证据支持或反驳在心脏骤停后恢复持续循环的昏迷儿童使用 32-34°C 的 TTM。未来的试验应集中在院外心脏骤停的儿童上。
