Deep versus moderate hypothermia in pediatric cardiac surgery: Systematic review and meta-analysis of early postoperative outcomes.
Ioannis Zoupas, Jared M Covell, Julieta Cruz Naranjo et al.
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In 30 seconds
This systematic review and meta-analysis compared deep hypothermia (DH; <22°C) with moderate hypothermia (MH; 22–30°C) during pediatric cardiac surgery. Five comparative studies included 448 patients, most undergoing aortic arch repair. Overall postoperative complications, acute kidney injury, 24-h chest drainage volume, and in-hospital mortality did not differ significantly between groups. Early postoperative neurological complications were significantly more frequent with DH (p < 0.001). The authors conclude that MH with regional perfusion may be a feasible alternative to DH, while noting that the evidence shows similar overall morbidity and mortality.
Key findings
- Five comparative studies included 448 patients: 250 in the MH group and 198 in the DH group.
- Early postoperative neurological complications were significantly more frequent with DH than MH (p < 0.001).
- Overall postoperative complications, acute kidney injury, 24-h chest drainage volume, and in-hospital mortality showed no significant group differences.
- Cross-clamp time was significantly longer with DH (p = 0.02), and circulatory arrest was more frequently used in DH patients (p = 0.01).
Why it matters
Temperature strategy is relevant to cerebral and visceral protection during pediatric cardiac surgery. The pooled findings suggest that MH may be associated with fewer early neurological complications without a detected difference in overall postoperative complications or in-hospital mortality. This comparison can inform evaluation of perfusion strategies, although the findings do not establish that temperature alone accounts for the neurological difference.
What to keep in mind
The meta-analysis included only five comparative studies, and DH patients more often underwent circulatory arrest and had longer cross-clamp times, complicating attribution of outcome differences to temperature strategy alone.