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Functional Outcome Trajectories After Out-of-Hospital Pediatric Cardiac Arrest
Faye S Silverstein1, Beth S Slomine, James Christensen
11Department of Pediatrics, University of Michigan, Ann Arbor, Michigan.2Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD.3Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.4Department of Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Baltimore, MD.5Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD.6Department of Pediatrics, University of Utah, Salt Lake City, Utah.
Insights
Functional performance scores in children after cardiac arrest reliably predict long-term outcomes. Early functional assessments at hospital discharge and 3 months are strong indicators of 12-month performance in survivors.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Cardiology
Background:
- Out-of-hospital cardiac arrest (OHCA) in children carries a high risk of poor neurological and functional outcomes.
- Effective management strategies, including targeted temperature management (TTM), are crucial for improving survival and recovery.
- Assessing functional performance is vital for understanding long-term recovery trajectories in pediatric OHCA survivors.
Purpose of the Study:
- To analyze functional performance measures in children resuscitated from OHCA.
- To evaluate the predictive value of early functional scores on long-term outcomes.
- To examine these relationships within the context of a clinical trial comparing TTM interventions.
Main Methods:
- Prospective data collection from a clinical trial involving children (up to 18 years) with Glasgow Motor Scale score < 5 after OHCA.
- Comparison of two TTM interventions (33.0°C vs. 36.8°C).
- Assessment of functional performance using the Vineland Adaptive Behavior Scale (VABS), second edition, Pediatric Cerebral Performance Category (PCPC), and Pediatric Overall Performance Category (POPC) at baseline, hospital discharge, 3 months, and 12 months.
Main Results:
- Hospital discharge PCPC scores strongly predicted 3- and 12-month PCPC and VABS-II scores (r = 0.82-0.77; p < 0.0001).
- Three-month VABS-II scores strongly predicted 12-month VABS-II scores (r = 0.95; p < 0.0001).
- TTM interventions did not alter these predictive relationships.
Conclusions:
- Functional scores obtained at hospital discharge and 3 months post-resuscitation are strong predictors of 12-month functional performance in pediatric OHCA survivors.
- These findings highlight the importance of early functional assessments for prognostication.
- The predictive value of these scores is consistent regardless of the TTM strategy employed.
Objectives:
To analyze functional performance measures collected prospectively during the conduct of a clinical trial that enrolled children (up to age 18 yr old), resuscitated after out-of-hospital cardiac arrest, who were at high risk of poor outcomes.
Design:
Children with Glasgow Motor Scale score less than 5, within 6 hours of resuscitation, were enrolled in a clinical trial that compared two targeted temperature management interventions (THAPCA-OH, NCT00878644). The primary outcome, 12-month survival with Vineland Adaptive Behavior Scale, second edition, score greater or equal to 70, did not differ between groups.
Setting:
Thirty-eight North American PICUs.
Participants:
Two hundred ninety-five children were enrolled; 270 of 295 had baseline Vineland Adaptive Behavior Scale, second edition, scores greater or equal to 70; 87 of 270 survived 1 year.
Interventions:
Targeted temperatures were 33.0°C and 36.8°C for hypothermia and normothermia groups.
Measurements And Main Results:
Baseline measures included Vineland Adaptive Behavior Scale, second edition, Pediatric Cerebral Performance Category, and Pediatric Overall Performance Category. Pediatric Cerebral Performance Category and Pediatric Overall Performance Category were rescored at hospital discharges; all three were scored at 3 and 12 months. In survivors with baseline Vineland Adaptive Behavior Scale, second edition scores greater or equal to 70, we evaluated relationships of hospital discharge Pediatric Cerebral Performance Category with 3- and 12-month scores and between 3- and 12-month Vineland Adaptive Behavior Scale, second edition, scores. Hospital discharge Pediatric Cerebral Performance Category scores strongly predicted 3- and 12-month Pediatric Cerebral Performance Category (r = 0.82 and 0.79; p < 0.0001) and Vineland Adaptive Behavior Scale, second edition, scores (r = -0.81 and -0.77; p < 0.0001). Three-month Vineland Adaptive Behavior Scale, second edition, scores strongly predicted 12-month performance (r = 0.95; p < 0.0001). Hypothermia treatment did not alter these relationships.
Conclusions:
In comatose children, with Glasgow Motor Scale score less than 5 in the initial hours after out-of-hospital cardiac arrest resuscitation, function scores at hospital discharge and at 3 months predicted 12-month performance well in the majority of survivors.
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