Duration of Induced Hypothermia After Pediatric Cardiac Arrest: A Systematic Review and Network Meta-Analysis

Background/Objectives: Pediatric guidelines retain induced hypothermia as an option, but its optimal duration is uncertain. We compared survival and favorable neurologic outcomes across duration-specific strategies. Methods: Five databases and ClinicalTrials.gov were searched through 20 August 2026. A random-effects network meta-analysis compared 24, 48, and 72 h hypothermia (HT) with heterogeneous Control strategies. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool and the Risk Of Bias In Non-randomized Studies of Interventions tool; certainty was assessed using Confidence in Network Meta-Analysis (CINeMA). Results: Survival included five studies (three randomized, two observational; 785 participants), and neurologic outcomes included four (three randomized, one observational; 615 participants). HT-72 h was associated with higher survival than Control (risk ratio [RR], 2.01; 95% confidence interval [CI], 1.24–3.25); 72% of this estimate derived from one observational study measuring 1-month survival, versus 12 months in the randomized 48 h trials. The estimate versus HT-48 h (RR, 1.77; 95% CI, 1.05–2.97) was entirely indirect and depended on merging different Control strategies. The neurologic estimate versus Control (RR, 10.92; 95% CI, 1.32–90.40) depended on a single observational study at serious risk of bias and was extremely imprecise. Superiority over shorter durations was not robust. Certainty for HT-72 h versus Control was very low for both outcomes. Conclusions: Evidence remains compatible with equipoise and does not establish an optimal duration. Funding: No external funding. Registration: Open Science Framework, 10.17605/OSF.IO/9MNDB (retrospective).