Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review

Abstract

Cardiac arrest (CA) in children offers high risks to survival, neurological function, and quality of life. 1 This condition compromises cerebral blood flow, damages neurons, and results in memory and concentration problems, cerebral palsy, seizures and, in extreme cases, vegetative state and death. 2CA causes ischemia and decreases oxygenation, producing cytotoxic edema due to cellular depolarization and the consequent influx of salt and water, extracellular accumulation of excitatory amino acids, and neuronal death. Therapeutic hypothermia (TH) is able to reduce neuronal metabolism, oxygen consumption, and cerebral blood flow, in addition to controlling depolarization and limiting cell death. [3][4][5][6] TH is used in adults and neonates who have suffered CA, but it is not yet indicated for children in the same situation because the cause of arrest in each of these groups is different: in children, CA mainly results from respiratory problems, while in adults it is mostly due to heart disease. This leads to different injury patterns, making it impossible to generalize the effectiveness of TH in these cases. 1,2,7 Evidence indicates that this