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Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials

Rebecca Ichord1, Faye S Silverstein2, Beth S Slomine2

  • 1From the Department of Neurology & Pediatrics (R.I.), Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania; University of Michigan (F.S.S., F.W.M.), Ann Arbor; Kennedy Krieger Institute and Johns Hopkins University (B.S.S., J.C.), Baltimore, MD; and University of Utah (R.T., R.H., J.M.D.), Salt Lake City. ichord@email.chop.edu.

Neurology
|June 10, 2018
PubMed

Insights

A new tool, the Pediatric Resuscitation after Cardiac Arrest (PRCA) form, effectively assesses neurologic outcomes in pediatric cardiac arrest survivors. This method shows strong correlation with existing measures, aiding in understanding long-term recovery.

Area of Science:

  • Pediatric critical care medicine
  • Neurology
  • Clinical trial methodology

Background:

  • Pediatric cardiac arrest (CA) survivors often experience significant neurologic deficits.
  • Standardized assessment of neurologic outcomes is crucial for evaluating interventions like therapeutic hypothermia.
  • Previous assessments lacked a comprehensive, semi-quantitative tool for detailed neurologic characterization.

Purpose of the Study:

  • To implement and validate the Pediatric Resuscitation after Cardiac Arrest (PRCA) form for characterizing neurologic outcomes in pediatric CA survivors.
  • To assess the correlation of the PRCA form with established neurobehavioral and cognitive measures at 12 months post-arrest.

Main Methods:

  • Two multicenter trials (THAPCA-OH and THAPCA-IH) enrolled comatose pediatric CA survivors randomized to therapeutic hypothermia or normothermia.
  • Neurologists assessed 181 12-month survivors using the novel PRCA form, rating neurologic impairment across 6 domains.
  • PRCA scores were compared with 12-month Vineland Adaptive Behavior Scales (VABS-II) and cognitive scores.

Main Results:

  • The PRCA form classified neurologic outcomes into 5 categories, from no/minimal to profound impairment.
  • PRCA scores demonstrated strong correlations with VABS-II (r = -0.88) and cognitive scores (r = -0.72), indicating robust validity.
  • Factors associated with poor outcomes included out-of-hospital CA and early seizure recognition.

Conclusions:

  • The PRCA form is a validated and robust method for assessing neurologic impairment after pediatric CA.
  • This tool provides a global, semi-quantitative rating and domain-specific information, valuable for research and clinical practice.
  • The PRCA's strong correlation with established measures supports its utility across diverse pediatric CA outcomes.
Abstract

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