TY - JOUR
T1 - Cardiac Arrest Outcomes in Children With Preexisting Neurobehavioral Impairment
AU - Christensen, James R.
AU - Slomine, Beth S.
AU - Silverstein, Faye S.
AU - Page, Kent
AU - Holubkov, Richard
AU - Dean, J. Michael
AU - Moler, Frank W.
N1 - Funding Information:
1Department of Pediatric Rehabilitation Medicine, Kennedy Krieger Institute, Baltimore, MD. 2Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD. 3Department of Pediatrics, Johns Hopkins University, Baltimore, MD. 4Department of Neuropsychology, Kennedy Krieger Institute, Baltimore, MD. 5Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD. 6Department of Pediatrics, University of Michigan, Ann Arbor, MI. 7Department of Neurology, University of Michigan, Ann Arbor, MI. 8Department of Pediatrics, University of Utah, Salt Lake City, UT. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ pccmjournal). All authors received support for article research from the National Institutes of Health (NIH). Drs. Christensen’s, Silverstein’s, and Dean’s institutions received funding from the National Heart, Lung, and Blood Institute. Drs. Slomine’s, Silverstein’s, Holubkov’s, and Moler’s institutions received funding from the NIH. Dr. Silverstein received funding from March of Dimes. Mr. Page received funding from the NIH. Dr. Holubkov received funding from Pfizer (Data Safety and Monitoring Board [DSMB] membership), Medimmune (DSMB membership), Physicians Committee for Responsible Medicine (biostatistical consulting), St. Jude Medical (biostatistical consulting), Armaron Bio (DSMB membership), American Burn Association (DSMB Membership), and DURECT Corporation (biostatistical consulting). Dr. Dean’s institution also received funding from the National Institute of Child Health and Human Development, the Health Resources and Services Administration, the Maternal and Child Health Bureau, and Emergency Medical Services for Children Program. Additional members of the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators are listed in Supplemental Appendix 1 (Supplemental Digital Content 7, http://links.lww.com/ PCC/A919). For information regarding this article, E-mail: Christensenj@kenne-dykrieger.org
Funding Information:
All authors received support for article research from the National Institutes of Health (NIH). Drs. Christensen's, Silverstein's, and Dean's institutions received funding from the National Heart, Lung, and Blood Institute. Drs. Slomine's, Silverstein's, Holubkov's, and Moler's institutions received funding from the NIH. Dr. Silverstein received funding from March of Dimes. Mr. Page received funding from the NIH. Dr. Holubkov received funding from Pfizer (Data Safety and Monitoring Board [DSMB] membership), Medimmune (DSMB membership), Physicians Committee for Responsible Medicine (biostatistical consulting), St. Jude Medical (biostatistical consulting), Armaron Bio (DSMB membership), American Burn Association (DSMB Membership), and DURECT Corporation (biostatistical consulting). Dr. Dean's institution also received funding from the National Institute of Child Health and Human Development, the Health Resources and Services Administration, the Maternal and Child Health Bureau, and Emergency Medical Services for Children Program.
Publisher Copyright:
© 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Objectives: To describe survival and 3-month and 12-month neurobehavioral outcomes in children with preexisting neurobehavioral impairment enrolled in one of two parallel randomized clinical trials of targeted temperature management. Design: Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital trials data. Setting: Forty-one PICUs in the United States, Canada, and United Kingdom. Patients: Eighty-four participants (59 in-hospital cardiac arrest and 25 out-of-hospital cardiac arrest), 49 males, 35 females, mean age 4.6 years (sd, 5.36 yr), with precardiac arrest neurobehavioral impairment (Vineland Adaptive Behavior Scales, Second Edition composite score < 70). All required chest compressions for greater than or equal to 2 minutes, were comatose and required mechanical ventilation after return of circulation. Interventions: Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting precardiac arrest status), and at 3 and 12 months postcardiac arrest, followed by on-site cognitive evaluation. Vineland Adaptive Behavior Scales, Second Edition norms are 100 (mean) ± 15 (sd); higher scores indicate better function. Analyses evaluated survival, changes in Vineland Adaptive Behavior Scales, Second Edition, and cognitive functioning. Measurements and Main Results: Twenty-eight of 84 (33%) survived to 12 months (in-hospital cardiac arrest, 19/59 (32%); out-of-hospital cardiac arrest, 9/25 [36%]). In-hospital cardiac arrest (but not out-of-hospital cardiac arrest) survival rate was significantly lower compared with the Therapeutic Hypothermia after Pediatric Cardiac Arrest group without precardiac arrest neurobehavioral impairment. Twenty-five survived with decrease in Vineland Adaptive Behavior Scales, Second Edition less than or equal to 15 (in-hospital cardiac arrest, 18/59 (31%); out-of-hospital cardiac arrest, 7/25 [28%]). At 3-months postcardiac arrest, mean Vineland Adaptive Behavior Scales, Second Edition scores declined significantly (-5; sd, 14; p < 0.05). At 12 months, Vineland Adaptive Behavior Scales, Second Edition declined after out-of-hospital cardiac arrest (-10; sd, 12; p < 0.05), but not in-hospital cardiac arrest (0; sd, 15); 43% (12/28) had unchanged or improved scores. Conclusions: This study demonstrates the feasibility, utility, and challenge of including this population in clinical neuroprotection trials. In children with preexisting neurobehavioral impairment, one-third survived to 12 months and their neurobehavioral outcomes varied broadly.
AB - Objectives: To describe survival and 3-month and 12-month neurobehavioral outcomes in children with preexisting neurobehavioral impairment enrolled in one of two parallel randomized clinical trials of targeted temperature management. Design: Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital trials data. Setting: Forty-one PICUs in the United States, Canada, and United Kingdom. Patients: Eighty-four participants (59 in-hospital cardiac arrest and 25 out-of-hospital cardiac arrest), 49 males, 35 females, mean age 4.6 years (sd, 5.36 yr), with precardiac arrest neurobehavioral impairment (Vineland Adaptive Behavior Scales, Second Edition composite score < 70). All required chest compressions for greater than or equal to 2 minutes, were comatose and required mechanical ventilation after return of circulation. Interventions: Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting precardiac arrest status), and at 3 and 12 months postcardiac arrest, followed by on-site cognitive evaluation. Vineland Adaptive Behavior Scales, Second Edition norms are 100 (mean) ± 15 (sd); higher scores indicate better function. Analyses evaluated survival, changes in Vineland Adaptive Behavior Scales, Second Edition, and cognitive functioning. Measurements and Main Results: Twenty-eight of 84 (33%) survived to 12 months (in-hospital cardiac arrest, 19/59 (32%); out-of-hospital cardiac arrest, 9/25 [36%]). In-hospital cardiac arrest (but not out-of-hospital cardiac arrest) survival rate was significantly lower compared with the Therapeutic Hypothermia after Pediatric Cardiac Arrest group without precardiac arrest neurobehavioral impairment. Twenty-five survived with decrease in Vineland Adaptive Behavior Scales, Second Edition less than or equal to 15 (in-hospital cardiac arrest, 18/59 (31%); out-of-hospital cardiac arrest, 7/25 [28%]). At 3-months postcardiac arrest, mean Vineland Adaptive Behavior Scales, Second Edition scores declined significantly (-5; sd, 14; p < 0.05). At 12 months, Vineland Adaptive Behavior Scales, Second Edition declined after out-of-hospital cardiac arrest (-10; sd, 12; p < 0.05), but not in-hospital cardiac arrest (0; sd, 15); 43% (12/28) had unchanged or improved scores. Conclusions: This study demonstrates the feasibility, utility, and challenge of including this population in clinical neuroprotection trials. In children with preexisting neurobehavioral impairment, one-third survived to 12 months and their neurobehavioral outcomes varied broadly.
KW - cardiac arrest
KW - neurobehavioral
KW - outcome
KW - pediatrics
KW - preexisting impairment
UR - http://www.scopus.com/inward/record.url?scp=85067176035&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067176035&partnerID=8YFLogxK
U2 - 10.1097/PCC.0000000000001897
DO - 10.1097/PCC.0000000000001897
M3 - Article
C2 - 30807545
AN - SCOPUS:85067176035
SN - 1529-7535
VL - 20
SP - 510
EP - 517
JO - Pediatric Critical Care Medicine
JF - Pediatric Critical Care Medicine
IS - 6
ER -