Faculty Collaboration Database

Pediatric cardiac arrest due to drowning and other respiratory etiologies: Neurobehavioral outcomes in initially comatose children. Resuscitation 2017 Jun;115:178-184

Date

03/10/2017

Pubmed ID

28274812

Pubmed Central ID

PMC5429171

DOI

10.1016/j.resuscitation.2017.03.007

Scopus ID

2-s2.0-85015297395 (requires institutional sign-in at Scopus site)   15 Citations

Abstract

AIM: To describe the 1-year neurobehavioral outcome of survivors of cardiac arrest secondary to drowning, compared with other respiratory etiologies, in children enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial.

METHODS: Exploratory analysis of survivors (ages 1-18 years) who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation (ROC). Participants recruited from 27 pediatric intensive care units in North America received targeted temperature management [therapeutic hypothermia (33°C) or therapeutic normothermia (36.8°C)] within 6h of ROC. Neurobehavioral outcomes included 1-year Vineland Adaptive Behavior Scales, Second Edition (VABS-II) total and domain scores and age-appropriate cognitive performance measures (Mullen Scales of Early Learning or Wechsler Abbreviated Scale of Intelligence).

RESULTS: Sixty-six children with a respiratory etiology of cardiac arrest survived for 1-year; 60/66 had broadly normal premorbid functioning (VABS-II≥70). Follow up was obtained on 59/60 (30 with drowning etiology). VABS-II composite and domain scores declined significantly from premorbid scores in drowning and non-drowning groups (p<0.001), although declines were less pronounced for the drowning group. Seventy-two percent of children had well below average cognitive functioning at 1-year. Younger age, fewer doses of epinephrine, and drowning etiology were associated with better VABS-II composite scores. Demographic variables and treatment with hypothermia did not influence neurobehavioral outcomes.

CONCLUSIONS: Risks for poor neurobehavioral outcomes were high for children who were comatose after out-of-hospital cardiac arrest due to respiratory etiologies; survivors of drowning had better outcomes than those with other respiratory etiologies.

Author List

Slomine BS, Nadkarni VM, Christensen JR, Silverstein FS, Telford R, Topjian A, Koch JD, Sweney J, Fink EL, Mathur M, Holubkov R, Dean JM, Moler FW, Therapeutic Hypothermia after Pediatric Cardiac Arrest THAPCA Trial Investigators

Author

Michael T. Meyer MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cardiopulmonary Resuscitation
Case-Control Studies
Child
Child, Preschool
Cognitive Dysfunction
Coma
Drowning
Female
Follow-Up Studies
Humans
Infant
Intensive Care Units, Pediatric
Male
Neuropsychological Tests
Out-of-Hospital Cardiac Arrest
Prospective Studies
Recovery of Function
Respiration, Artificial
Risk Factors