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Targeted Temperature Management Strategies in Pediatric Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Grading of Recommendations, Assessment, Development, and Evaluation-Assessed Systematic Review and Meta-Analysis
Journal article   Peer reviewed

Targeted Temperature Management Strategies in Pediatric Patients with Return of Spontaneous Circulation after Out-of-Hospital Cardiac Arrest: A Grading of Recommendations, Assessment, Development, and Evaluation-Assessed Systematic Review and Meta-Analysis

Mohammed Alsabri, Shree Rath, Ibrahim Kamal, Salma Tamer Abdelrahman, Mayam Mohamed Aziz, Eric Lusinski and Zena Saleh
Therapeutic hypothermia and temperature management, v 16(3), pp 87-96
01 Sep 2026
PMID: 40956682
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Abstract

Child Child, Preschool Humans Hypothermia, Induced - adverse effects Hypothermia, Induced - methods Hypothermia, Induced - mortality Infant Odds Ratio Out-of-Hospital Cardiac Arrest - diagnosis Out-of-Hospital Cardiac Arrest - mortality Out-of-Hospital Cardiac Arrest - physiopathology Out-of-Hospital Cardiac Arrest - therapy Return of Spontaneous Circulation Risk Factors Time Factors Treatment Outcome
Out-of-hospital cardiac arrest (OHCA) in children is a rare but catastrophic event, often resulting in significant neurological injury. Targeted temperature management (TTM), including therapeutic hypothermia (TH), has been proposed as a neuroprotective strategy. This systematic review and meta-analysis aims to evaluate the effects of different TTM strategies on survival and neurological outcomes in pediatric patients after OHCA. A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Pooled outcomes were synthesized using odds ratios (OR) with 95% confidence intervals (CI), and the certainty of evidence was appraised using the Grading of Recommendations, Assessment, Development, and Evaluation approach. A total of nine studies encompassing 2107 pediatric patients were included. TH was associated with significantly higher odds of survival (OR: 1.72; 95% CI: 1.36-2.18; < 0.0001) and favorable neurological outcome (OR: 1.64; 95% CI: 1.16-2.33; = 0.006) compared to normothermia. Subgroup analysis demonstrated greater survival benefit at 12 months and improved neurological outcomes at 6-12 months. There were no statistically significant differences between groups in blood lactate levels, odds of arrhythmia, culture-proven infections, or length of hospital stay. The certainty of evidence for most outcomes was graded as low due to the predominance of nonrandomized studies and imprecision. TH as a TTM strategy following pediatric OHCA may offer survival and neurological advantage, particularly at longer-term follow-up, without a significant increase in adverse events. However, the low certainty of evidence highlights the need for further high-quality randomized trials to inform clinical practice and optimize neuroprotective care in this vulnerable population.

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Critical Care Medicine
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