Abstract
Aim: The aim of the current study was to identify early clinical predictors of neurologic outcome in children with asphyxial out-of-hospital cardiac arrest (OHCA) treated with therapeutic hypothermia.Methods: The present retrospective cohort study of comatose children treated with therapeutic hypothermia or normothermia after asphyxial OHCA was conducted between January 2010 and June 2018. All children aged between 1 month and 18 years of age, with a history of at least 3 min of chest compressions were eligible for inclusion. Their 6-month neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) score and early clinical predictors were determined.Results: A total of 100 patients met the eligibility criteria for the study. Sixty-four (64%) of the children were male, and the mean age of participants was 4.59 ± 5.45 years. Forty (40%) of the children had underlying disorders. The overall 1-month survival rate was 36%. Only 12 (12%) of the patients had favorable outcomes (PCPC ≤ 2). Thirty-four (34%) of the 100 children were receiving therapeutic hypothermia. In the univariate analysis, an initial lactate level of ≤ 80 mg/dL, a Glasgow coma scale (GCS) score of 5–8, a GCS motor score ≥4 and a present pupil reflex before therapeutic hypothermia, were significantly associated with favorable 6-month neurological outcomes. However, after the multivariate logistic analysis, only initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with favorable 6-month neurological outcomes.Conclusion: Initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with 6-month favorable neurological outcomes in pediatric asphyxial OHCA patients who were treated with therapeutic hypothermia. Therefore, these early clinical predictors could be helpful to facilitate future clinical research in children with asphyxial OHCA treated with therapeutic hypothermia.
Highlights
Despite advances in resuscitation for pediatric out-of-hospital cardiac arrest (OHCA), pediatric asphyxial OHCA is still associated with high mortality and morbidity
There were no significant differences in the demographic data, including age, gender, the presence of chronic illnesses, bystander-witnessed cardiac arrest, bystander performed cardiopulmonary resuscitation (CPR), and first documented arrest rhythm, between the favorable and unfavorable outcome groups in the therapeutic hypothermia and normothermia
The univariate analysis revealed four clinical parameters were significantly associated with 6-month favorable neurological outcomes, including the initial serum lactate level, the Glasgow coma scale (GCS), a GCS motor score ≥4 and the presence of a pupil reflex before therapeutic hypothermia
Summary
Despite advances in resuscitation for pediatric out-of-hospital cardiac arrest (OHCA), pediatric asphyxial OHCA is still associated with high mortality and morbidity. For infants and children who remain comatose after OHCA, advanced pediatric life support guidelines recommend to either maintain 5 days of continuous normothermia (36–37.5◦C), or to maintain 2 days of initial continuous hypothermia (32– 34◦C) followed by 3 days of continuous normothermia [1, 2]. In a recent publication by the authors, 3 days of therapeutic hypothermia was associated with a better 1-month survival rate and 6-month neurological outcomes compared with 5 days normothermia in pediatric asphyxial OHCA [3]. Clinical predictors in children with asphyxia OHCA are important for counseling families and making management decisions. The aim of the present study was to identify early clinical predictors of neurologic outcome in children with asphyxial OHCA treated with therapeutic hypothermia
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