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Real-Time Assessment of Factors Impacting Prognostic Predictions After Pediatric Cardiac Arrest: A Single-Center
Megan L McSherry1, Bingqing Zhang2, Lauren Louderback1
1Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Insights
Pediatric cardiac arrest survivors
Area of Science:
- Pediatric critical care medicine
- Neuroprognostication
- Pediatric cardiology
Background:
- Children experiencing cardiac arrest face high mortality and morbidity risks, with survivors often suffering significant neurobehavioral deficits.
- Accurate prognostication is challenging yet crucial, as provider predictions influence patient outcomes.
- Real-time clinical factors used by providers to predict outcomes in pediatric cardiac arrest are not well understood.
Purpose of the Study:
- To identify the clinical factors multidisciplinary providers use in real time to predict survival and neurologic outcomes in pediatric cardiac arrest patients.
- To examine how these predictive factors vary by provider characteristics, patient factors, and time elapsed since the arrest.
Main Methods:
- A single-center prospective observational study was conducted at a pediatric intensive care unit (PICU) over 12 months.
- Multidisciplinary providers assessing pediatric patients resuscitated from in-hospital or out-of-hospital cardiac arrest (OHCA) completed questionnaires on post-arrest days 1, 2, 3, and 7.
- Data collected included patient demographics, provider demographics, and factors influencing their prognosis predictions.
Main Results:
- Sixty-four pediatric patients (median age 4.1 years, 60% OHCA) were analyzed, with 548 questionnaires completed by 245 providers.
- Baseline neurologic function and clinical neurologic examination were consistently the most reported factors for prognosis.
- The use of intra-arrest factors decreased over time, while reliance on neuromonitoring and neuroimaging increased; factor use differed by provider discipline and patient/arrest characteristics.
Conclusions:
- Prognostic predictions in pediatric cardiac arrest are dynamic, influenced by patient-specific characteristics and the provider's discipline.
- Further research is needed to understand how integrating patient data affects prognostic accuracy.
- Clarifying how prognostic impressions impact caregiver communication and clinical decision-making is essential.
Objectives:
Children who suffer cardiac arrest are at risk of mortality and morbidity, with survivors often experiencing a severe decline in neurobehavioral function. Despite challenges in neuroprognostication, providers frequently make predictions regarding patient recovery that influence outcomes. We aimed to determine the clinical factors providers report using in real time to predict patient survival and neurologic outcomes at discharge, and how these factors differ by provider and patient characteristics, and time from arrest.
Design:
Single center prospective observational study.
Setting:
The Children's Hospital of Philadelphia PICU over 12 months, 2023-2024.
Patients:
Children resuscitated from in-hospital cardiac arrest and out-of-hospital cardiac arrest (OHCA) who received post-arrest care in the PICU.
Subjects:
Multidisciplinary providers of post-cardiac arrest patients.
Interventions:
None.
Measurements And Main Results:
Multidisciplinary team members completed questionnaires on post-arrest days 1, 2, 3, and 7, eliciting demographic data and factors used to form their prediction. Descriptive statistics summarized patient characteristics, provider demographics, and survey data. Mixed-effect models explored changes in factors used for the prediction of patient discharge outcome over survey time points, as well as differences by provider and patient characteristics. Overall, 64 patients (median age, 4.1 yr [interquartile range, 1.2-9.4 yr]; 60% OHCA; and 55% pre-arrest Pediatric Cerebral Performance Category = 1) were analyzed. Five hundred forty-eight questionnaires were completed by 245 unique providers. Across all time points, baseline neurologic function and clinical neurologic examination were the most frequently reported factors used to inform prognosis. Use of intra-arrest factors decreased, while reliance on neuromonitoring and neuroimaging increased over time. Factor use varied by provider discipline and patient and arrest characteristics.
Conclusions:
Prognostic predictions after pediatric cardiac arrest were dynamic and influenced by both patient characteristics and provider discipline. Future efforts should aim to understand how the integration of patient data impacts prognostic accuracy and clarify how prognostic impressions shape communication and decision-making with caregivers.
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