Extracorporeal Cardiopulmonary Resuscitation: One-Year Survival and Neurobehavioral Outcome among Infants and Children with In-Hospital Cardiac Arrest∗

Kathleen L. Meert, Anne Marie Guerguerian, Ryan Barbaro, Beth S. Slomine, James R. Christensen, John Berger, Alexis Topjian, Melania Bembea, Sarah Tabbutt, Ericka L. Fink, Steven M. Schwartz, Vinay M. Nadkarni, Russell Telford, J. Michael Dean, Frank W. Moler

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)393-402
Number of pages10
JournalCritical care medicine
Volume47
Issue number3
DOIs
StatePublished - Mar 1 2019

Keywords

  • adaptive behavior
  • cardiac arrest
  • children
  • extracorporeal cardiopulmonary resuscitation
  • infants

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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