[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].
Zhonghua wei zhong bing ji jiu yi xue · 2017-10-01 · Meta-analysis
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 3 555 cases were included, among which 1 804 cases were assigned to the treatment group and 1 751 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 < 0.000 01]. 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. CONCLUSIONS: Pre-hospital therapeutic hypothermia after OHCA can decrease temperature at hospital admission, but cannot increase the survival rate and neurological outcome at hospital discharge.