Related Experiment Video
Updated: Aug 26, 2026
Pediatric Animal Model of Extracorporeal Cardiopulmonary Resuscitation After Prolonged Circulatory Arrest
Published on: May 26, 2023
A multimodal model integrating early clinical and biomarker data to predict 1-year outcomes after pediatric cardiac
Hugues Yver1, Patrick M Kochanek2, Robert S B Clark2
1Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA; Safar Center for Resuscitation Research, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Background:
Shared decision-making after pediatric cardiac arrest (CA) requires early, accurate prognostication. We analyzed whether adding brain injury biomarkers and neuroimaging findings to clinical models increased prognostic accuracy after pediatric CA.
Methods:
This planned analysis of the POCCA study included children aged 48 h-17 years with ICU admission after CA. Clinical predictors included demographic, CA, and resuscitation variables. Blood neurofilament light, ubiquitin carboxyl-terminal esterase L1, glial fibrillary acidic protein, and tau were measured on day 1 post-CA. MRI Injury Score was assessed within 2 weeks post-CA. Primary outcome was unfavorable outcome (death or Vineland Adaptive Behavior Scale <70) at 1 year. Likelihood ratio tests (LRT) compared model fit with and without biomarkers. Four alternative models were analyzed in an Outcomes Cohort using bootstrap-generated AUROCs, and we assessed whether MRI Injury Score provided incremental value.
Results:
Of 163 enrolled children, 118 with day 1 biomarker data and clinical predictors formed the Outcomes Cohort. Biomarkers improved model fit over clinical variables alone in the Outcomes Cohort (LRT p = 0.002), but not in the full, imputed POCCA Cohort (LRT p = 0.07). The penalized regression model showed the highest discrimination among four approaches (optimism-corrected AUROC, 0.868 [95% CI, 0.82-0.94]; calibration intercept, 0.050 [0.00-0.26]; calibration slope, 1.067 [1.00-1.47]). The addition of MRI Injury Score improved predictive performance (aOR = 1.13; 95% CI, 1.03-1.24, p = 0.016).
Conclusions:
Brain injury biomarkers and MRI Injury Score improved prognostic accuracy over clinical variables alone for 1-year outcome in the Outcomes Cohort. External validation is needed before these findings can inform clinical decision-making.