• Jason E Buick, Clare Wallner, Richard Aickin, Peter A Meaney, Allan de Caen, Ian Maconochie, Markus B Skrifvars, Michelle Welsford, and International Liaison Committee on Resuscitation Pediatric Life Support Task Force.
• Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street - Room 425, Toronto, ON M5R 3M6, Canada. Electronic address: jason.buick@mail.utoronto.ca.
• Resuscitation. 2019 Jun 1; 139: 65-75.

IntroductionThe 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.MethodsElectronic 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.ResultsTwelve 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.ConclusionThere 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.Copyright © 2019 Elsevier B.V. All rights reserved.

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