Pre-hospital therapeutic hypothermia for survival and neuro-protection after out-of-hospital cardiac arrest:a systematic review and Meta-analysis of randomized controlled trials / 中华危重病急救医学

ABSTRACT

Objective To assess the effectiveness of pre-hospital therapeutic hypothermia after out-of-hospital cardiac arrest (OHCA) for survival and neuro-protection.Methods Databases such as Medline, ScienceDirect, Embase, Highwire, Cochrane Library, CNKI and Wanfang digital database were searched from January 2000 to March 2017 to retrieve randomized controlled trials (RCTs) on pre-hospital therapeutic hypothermia after OHCA. Thereafter, the studies retrieved were screened based on predefined inclusion and exclusion criteria. Data were extracted and the quality of the included studies was evaluated. A Meta-analysis was performed using the Cochrane Collaboration RevMan 4.3 software. Analysis of publication bias was depicted by funnel plot.Results Eight studies involving 3555 cases were included, among which 1804 cases were assigned to the treatment group and 1751 cases to the control group. Meta-analysis showed that compared with in-hospital therapeutic hypothermia, pre-hospital therapeutic hypothermia did not improve the survival rate of patients with OHCA [odds ratio (OR) = 1.00, 95％ confidence interval (95％CI) =0.85-1.18,P = 0.99], and neurological outcome at hospital discharge (OR = 0.97, 95％CI = 0.80-1.16,P = 0.71), but the body temperature was significantly lowered at admission [weighted mean difference (SMD) = -0.88, 95％CI = -1.03 to-0.73,P < 0.00001]. The funnel plot suggested that there was no publication bias in the 8 studies. But due to the low number of studies, the publication bias could not be completely excluded.Conclusion Pre-hospital therapeutic hypothermia after OHCA can decrease temperature at hospital admission, but cannot increase the survival rate and neurological outcome at hospital discharge.