Neurobehavioral Outcomes After Cardiac Arrest

Abstract

Research Article| June 01 2016 Neurobehavioral Outcomes After Cardiac Arrest AAP Grand Rounds (2016) 35 (6): 65. https://doi.org/10.1542/gr.35-6-65 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Neurobehavioral Outcomes After Cardiac Arrest. AAP Grand Rounds June 2016; 35 (6): 65. https://doi.org/10.1542/gr.35-6-65 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: cardiac arrest, out-of-hospital cardiac arrest Slomine BS, Silverstein FS, Christensen JR, et al. Neurobehavioral outcomes in children after out-of-hospital cardiac arrest. Pediatrics. 2016; 137(4): e20153412; doi: https://doi.org/10.1542/peds.2015-3412Google Scholar Investigators from multiple institutions sought to determine the neurobehavioral outcomes 12 months following out-of-hospital cardiac arrest (OH-CA) among children who were comatose following resuscitation. Participants in the current study consisted of a subgroup of children who had been enrolled in a clinical trial, Therapeutic Hypothermia After Pediatric Cardiac Arrest, Out-Of-Hospital (THAPCA-OH), to determine whether targeted temperature management to hypothermia (33.0°C) was more beneficial than targeting to normothermia (36.8°C). Neurobehavioral function was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II). The VABS-II measures functional skills and provides age-corrected standard scores. A baseline score, based on functioning before OH-CA, was obtained from caregivers within 24 hours of enrollment and compared to scores obtained 12 months after the event. Only participants with normal (>70) baseline composite VABS-II scores were eligible for this study. The primary outcome was change in VABS-II scores from baseline to follow-up in each study child; statistical significance of the change was assessed with paired t-tests. Regression models were used to identify independent associations with change in composite VABS-II scores. Of the 295 children, aged 2 days to 18 years, enrolled in the THAPCA-OH study, 96 were alive at 12 months post-arrest. Among these 96 survivors, 87 had normal baseline composite VABS-II scores and were eligible for the current study. Follow-up was completed in 85 of the 87. VABS-II composite, domain, and subdomain scores in study participants declined significantly between baseline and the 12-month follow-up (P < .001 for all comparisons). Mean baseline scores ranged from 95–106; mean follow-up scores ranged from 68–81. The mean change in composite VABS-II score was −21 for children <3 years of age, −28 for children 3–6 years of age and −46 for children ≥6 years of age. At 12-month follow-up, 49% (42/85) of the children had normal VABS-II scores (≥70) and 38% (32/85) had composite scores within 15 points of their baseline. Most children also demonstrated below average cognitive functioning at the 12-month followup. Treatment with hypothermia did not influence neurobehavioral outcomes. In the multivariate analysis, older age at the time of arrest and higher baseline VABS-II score were independent predictors of decline in composite VABS-II scores following OH-CA. The investigators conclude that significant neurobehavioral deficits persist in children surviving OH-CA who were comatose after resuscitation. Younger age at the time of arrest was associated with better neurobehavioral outcome. Dr Anderson has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Pediatric OH-CA is a rare event occurring in ~8/100,000 person-years (compared to 126/100,000 person-years in the adult population).1 Children who experience in-hospital cardiac arrest undergo more rapid resuscitation and presumably have less incremental brain injury.2 The results of the current study not only highlight the poor survival... You do not currently have access to this content.