Wieczorek Wojciech, Meyer-Szary Jarosław, Jaguszewski Milosz J, Filipiak Krzysztof J, Cyran Maciej, Smereka Jacek, Gasecka Aleksandra, Ruetzler Kurt, Szarpak Lukasz
Department of Emergency Medicine, Medical University of Warsaw, 02-091 Warsaw, Poland.
Polish Society of Disaster Medicine, 50-345 Warsaw, Poland.
J Clin Med. 2021 Mar 30;10(7):1389. doi: 10.3390/jcm10071389.
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 ( = 2002 patients) were included, comparing TTM patients ( = 638) with controls ( = 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; = 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.
心脏骤停（CA）与高死亡率和低生活质量相关。目标温度管理（TTM）或治疗性低温是一种可提高成年CA患者生存率的疗法。本研究旨在评估小儿CA后治疗性低温的可行性。我们对评估小儿CA后TTM应用的随机对照试验和观察性研究进行了系统评价和荟萃分析。主要结局是出院生存率或30天生存率。次要结局包括一年生存率、文兰适应行为量表（VABS-II）评分≥70的生存率以及不良事件的发生情况。纳入了10篇文章（共2002例患者），比较了TTM组（638例）和对照组（1364例）。在固定效应荟萃分析中，TTM组的出院生存率为49.7%，高于非TTM组（43.5%；优势比，OR = 1.22；95%置信区间，CI：1.00，1.50；P = 0.06）。TTM组和非TTM组在一年生存率或不良事件发生率方面没有差异。总体而言，TTM的使用与更高的出院生存率相关；然而，它并没有显著提高年生存率。需要更多高质量的前瞻性研究来证实TTM的其他益处。
