Pediatric cardiac arrest survivability
Pediatric cardiac arrest (CA) is a sudden and extremely devestating event with a low survival rate. This is specifically true for out of hospital cardiac arrest (OHCA) cases. It has been shown that only 2-27% of CA patients survive until hospital discharge. However, among the discharged patients, about 50-75% of them experience a long term physical and psychological burdens, adversely affecting their quality of life.
This problem has been studied extensively to seek new treatments and refine existing protocols in hope of improvements. In recent decades, professionals have high hopes for targeted temperature management (TTM), also known as therapeutic hypothermia. It is the process of cooling the patient externally (using water, fanning, ice padding, blankets, caps) and/or internally (using gastric lavage, bladder cooling, intravascular cooling via a catheter) after the return of spontaneous circulation. None of these methods has shown a clear edge over another. There is no uniform globally accepted protocol, but it is generally agreed upon that the desired temperature range for TTM is 32–34 °C, with a minimum application time of 12 hours.
Is targeted temperature management (TTM) really effective ?
A meta-analysis was conducted by J Clin Med in 2021 of 2002 CA patients to verify the effect of TTM. The analysis studied and compared the survival rates between patients who received TTM treatment and those who did not. The results shows there is an increase in survival rate among patients of the TTM group compared to the other. When considering the 30 days survival rate, patients of the TTM group has a higher rate of survivability. Unfortunately, when comparing the rates between these group at 6 months and 1 year interval, there is close to no difference. This result is said to not be statistically significant enough to prove TTM is effective in treating patients of post cardiac arrest.
However, this does not prove that TTM has no effect in treating patients of post cardiac arrest. There are a lot of factors to take into consideration in the post-discharge period that can affect a patient's survivability and recovery. This includes the diagnosis and treatment of diseases that are the underlying causes of CA, as well as home monitoring technology to prevent a secondary CA.
Conclusion
TTM is shown to produce better (but not statistically significant) outcome for CA patients within the 30 days period, but not on any other endpoint. Currently, TTM should still be considered and applied in strictly controlled environmental settings, preferably as well-planned, high-quality multicenter RCTs with a long-term follow-up. Further studies are necessary, because most research at hand was based on a mixed pediatric population with various underlying morbidities and causes leading to CA.
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