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Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome Among Infants and
Kathleen L Meert1,2, Anne-Marie Guerguerian3,4, Ryan Barbaro5
1Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI.
Insights
About one third of children survived with good neurobehavioral outcomes after in-hospital cardiac arrest treated with extracorporeal cardiopulmonary resuscitation. Open-chest cardiac massage was linked to better survival with good neurobehavioral outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Neuroscience
- Cardiology
Background:
- In-hospital cardiac arrest (IHCA) in children presents significant neurobehavioral challenges.
- Extracorporeal cardiopulmonary resuscitation (ECPR) is a life-saving intervention for IHCA.
- Understanding long-term neurobehavioral outcomes after ECPR is crucial for patient management.
Purpose of the Study:
- To describe neurobehavioral outcomes 1 year after pediatric IHCA treated with ECPR.
- To identify factors associated with survival and good neurobehavioral outcomes at 1 year post-ECPR.
Main Methods:
- Secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital trial.
- Neurobehavioral status assessed using Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline and 12 months.
- Multivariable analyses investigated associations with survival and neurobehavioral outcomes.
Main Results:
- 61 of 147 children (41.5%) survived to 12 months.
- 32 children (22.1%) survived with VABS-II scores decreased by ≤15 points from baseline.
- 39 children (30.5%) survived with VABS-II scores ≥70.
- Open-chest cardiac massage associated with better survival with good neurobehavioral outcomes.
- Higher postarrest lactate and preexisting GI conditions associated with poorer neurobehavioral outcomes.
Conclusions:
- Approximately one-third of children achieved good neurobehavioral outcomes 1 year after ECPR for IHCA.
- Open-chest cardiac massage emerged as a positive prognostic factor for neurobehavioral recovery.
- Postarrest lactate levels and gastrointestinal conditions are important factors influencing neurobehavioral outcomes.
Objective:
To describe neurobehavioral outcomes and investigate factors associated with survival and survival with good neurobehavioral outcome 1 year after in-hospital cardiac arrest for children who received extracorporeal cardiopulmonary resuscitation.
Design:
Secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital trial.
Setting:
Thirty-seven PICUs in the United States, Canada, and the United Kingdom.
Patients:
Children (n = 147) resuscitated with extracorporeal cardiopulmonary resuscitation following in-hospital cardiac arrest.
Interventions:
Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition, at prearrest baseline and 12 months postarrest. Norms for Vineland Adaptive Behavior Scales, Second Edition, are 100 (mean) ± 15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival, 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points from baseline, and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70.
Measurements And Main Results:
Of 147 children receiving extracorporeal cardiopulmonary resuscitation, 125 (85.0%) had a preexisting cardiac condition, 75 (51.0%) were postcardiac surgery, and 84 (57.1%) were less than 1 year old. Duration of chest compressions was greater than 30 minutes for 114 (77.5%). Sixty-one (41.5%) survived to 12 months, 32 (22.1%) survived to 12 months with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points from baseline, and 39 (30.5%) survived to 12 months with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70. On multivariable analyses, open-chest cardiac massage was independently associated with greater 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points and greater 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70. Higher minimum postarrest lactate and preexisting gastrointestinal conditions were independently associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points and lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70.
Conclusions:
About one third of children survived with good neurobehavioral outcome 1 year after receiving extracorporeal cardiopulmonary resuscitation for in-hospital arrest. Open-chest cardiac massage and minimum postarrest lactate were associated with survival with good neurobehavioral outcome at 1 year.
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