TY - JOUR
T1 - Neuropsychological Outcomes of Children 1 Year after Pediatric Cardiac Arrest
T2 - Secondary Analysis of 2 Randomized Clinical Trials
AU - Slomine, Beth S.
AU - Silverstein, Faye S.
AU - Christensen, James R.
AU - Page, Kent
AU - Holubkov, Richard
AU - Dean, J. Michael
AU - Moler, Frank W.
N1 - Funding Information:
Additional support from the following federal planning grants contributed to the planning of the THAPCA Trials: NIH, Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), Bethesda, MD. HD044955 (FWM) and HD050531 (FWM).
Funding Information:
The project described was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR000003. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Funding Information:
J. Berger (PI), D. Wessel (Sub-I), M. Sharron (Sub-I), S. Basu (Sub-I), A. Wratney (Sub-I), N. Dean (Sub-I), J. Reardon (CRC), E. Tomanio (CRC), J. Carpenter (Neurologist), S. Swanson (Psychologist), T. Brennan (Psychologist), P. Glass (Psychologist), B. Malek (Psychologist), M. Mintz (Psychologist) Our follow ups were conducted in the Clinical Research Center which is supported by NIH P30HD040677 Medical College of Wisconsin, Milwaukee, WI M. T. Meyer (PI), M. Wakeham (Sub-I), S. Hanson (Sub-I), K. Murkowski (CRC)
Funding Information:
“Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1 TR 000433 and UL1 TR 000433. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”
Funding Information:
Primary support for the conduct of the THAPCA-IH and OH Trial was funding from the National Institutes of Health (NIH), National Heart, Lung, and Blood Institute, Bethesda, MD. HL094345 (FWM) and HL094339 (JMD).
Funding Information:
The Therapeutic Hypothermia After Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital (THAPCA-IH and OH) trials were primarily supported by funding from the National Institutes of Health National Heart, Lung, and Blood Institute grants HL094345 (Dr Moler) and HL094339 (Dr Dean). Additional support from the Eunice Kennedy Shriver National Institute of Child Health and Development federal planning grants HD044955 and HD050531 (both, Dr Moler) contributed to the planning of the THAPCA Trials.
Funding Information:
“Research reported in this publication was supported by the Eunice Kennedy Shriver National Institute Of Child Health & Human Development of the National Institutes of Health under Award Number U54 HD087011 to the Intellectual and Developmental Disabilities Research Center at Washington University. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.”
Funding Information:
After Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital (THAPCA-IH and OH) trials were primarily supported by funding from the National Institutes of Health National Heart, Lung, and Blood Institute grants HL094345 (Dr Moler) and HL094339 (Dr Dean). Additional support from the Eunice Kennedy Shriver National Institute of Child Health and Development federal planning grants HD044955 and HD050531 (both, Dr Moler) contributed to the planning of the THAPCA Trials. In-part support was drawn from the participation of the Pediatric Emergency Care Applied Research Network and the Collaborative Pediatric Critical Care Research Network. At several centers (see eAppendix in the Supplement), clinical research support was supplemented by the following grants or Cooperative Agreements: UL1TR000003, P30HD040677, UL1 TR 000433 and U54 HD087011.
Publisher Copyright:
© 2018 2018 American Medical Association. All rights reserved.
PY - 2018/12
Y1 - 2018/12
N2 - Importance: Little is known about neuropsychological outcomes of children who survived pediatric cardiac arrest (CA). Objective: To describe the neuropsychological outcomes of CA survivors enrolled in the Therapeutic Hypothermia After Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) and Out-of-Hospital (THAPCA-OH) trials and compare the results with the primary outcome measure for these trials. Design, Setting, and Participants: Secondary analysis of 222 CA survivors aged 1 to 18 years who received chest compressions for 2 minutes or more, remained comatose and required mechanical ventilation after return of circulation, and were enrolled in targeted temperature-management trials from 41 pediatric intensive care units. Data were collected from September 3, 2009, to February 3, 2016, and analyzed from March 10, 2017, to April 20, 2018. Main Outcomes and Measures: The Vineland Adaptive Behavior Scales, Second Edition (VABS-II), a standardized measure of neurobehavioral functioning based on caregiver report (age-corrected mean [SD] scores = 100 [15]), was used to evaluate pre-CA functioning within 24 hours after enrollment; VABS-II<70 indicated significant developmental delays; VABS-II and neuropsychological testing were completed 1 year after CA. Neuropsychological testing included the Mullen Scales of Early Learning (Mullen) for children younger than 6 years and the Wechsler Abbreviated Scale of Intelligence (WASI) and neuropsychological measures of attention, memory, processing speed, and executive functioning for older children. Results: Of 160 participants who completed neuropsychological testing, 96 (60.0%) were male; the median (interquartile range [IQR]) age was 2.5 years (1.3-6.1 years). Ninety-six (60.0%) were white, 41 (25.6%) were black, and 23 (14.4%) were of other/unknown race; 343 (21.2%) were Hispanic or Latino; 119 (74.4%) were non-Hispanic or Latino; and 7 (4.4%) were of unknown ethnicity. One hundred fourteen participants (71.2%) were classified as having favorable outcomes (VABS-II ≥70). Impairments (>2 SD below the mean for age) across neuropsychological measures ranged from 7% to 61%. Correlations between global cognitive and VABS-II scores were strong for younger children (Mullen, r = 0.69-0.87) but moderate for older children (r = 0.21-0.54 for the WASI). Of 111 children with favorable outcomes on VABS-II, 25.2% had global cognitive impairment and 30 of 35 older children (85.7%) had selective neuropsychological deficits. Conclusions and Relevance: In this prospectively evaluated cohort of pediatric CA survivors who were initially comatose, although 71.2% were classified as having favorable outcomes, significant neuropsychological deficits were identified in pediatric CA survivors who were classified as having favorable outcomes. The findings provide clinicians with a greater understanding of the spectrum of neuropsychological outcomes of pediatric CA survivors and the complex relationship between standardized caregiver-reported functional outcome measures incorporated in clinical trials and performance-based neuropsychological assessments..
AB - Importance: Little is known about neuropsychological outcomes of children who survived pediatric cardiac arrest (CA). Objective: To describe the neuropsychological outcomes of CA survivors enrolled in the Therapeutic Hypothermia After Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) and Out-of-Hospital (THAPCA-OH) trials and compare the results with the primary outcome measure for these trials. Design, Setting, and Participants: Secondary analysis of 222 CA survivors aged 1 to 18 years who received chest compressions for 2 minutes or more, remained comatose and required mechanical ventilation after return of circulation, and were enrolled in targeted temperature-management trials from 41 pediatric intensive care units. Data were collected from September 3, 2009, to February 3, 2016, and analyzed from March 10, 2017, to April 20, 2018. Main Outcomes and Measures: The Vineland Adaptive Behavior Scales, Second Edition (VABS-II), a standardized measure of neurobehavioral functioning based on caregiver report (age-corrected mean [SD] scores = 100 [15]), was used to evaluate pre-CA functioning within 24 hours after enrollment; VABS-II<70 indicated significant developmental delays; VABS-II and neuropsychological testing were completed 1 year after CA. Neuropsychological testing included the Mullen Scales of Early Learning (Mullen) for children younger than 6 years and the Wechsler Abbreviated Scale of Intelligence (WASI) and neuropsychological measures of attention, memory, processing speed, and executive functioning for older children. Results: Of 160 participants who completed neuropsychological testing, 96 (60.0%) were male; the median (interquartile range [IQR]) age was 2.5 years (1.3-6.1 years). Ninety-six (60.0%) were white, 41 (25.6%) were black, and 23 (14.4%) were of other/unknown race; 343 (21.2%) were Hispanic or Latino; 119 (74.4%) were non-Hispanic or Latino; and 7 (4.4%) were of unknown ethnicity. One hundred fourteen participants (71.2%) were classified as having favorable outcomes (VABS-II ≥70). Impairments (>2 SD below the mean for age) across neuropsychological measures ranged from 7% to 61%. Correlations between global cognitive and VABS-II scores were strong for younger children (Mullen, r = 0.69-0.87) but moderate for older children (r = 0.21-0.54 for the WASI). Of 111 children with favorable outcomes on VABS-II, 25.2% had global cognitive impairment and 30 of 35 older children (85.7%) had selective neuropsychological deficits. Conclusions and Relevance: In this prospectively evaluated cohort of pediatric CA survivors who were initially comatose, although 71.2% were classified as having favorable outcomes, significant neuropsychological deficits were identified in pediatric CA survivors who were classified as having favorable outcomes. The findings provide clinicians with a greater understanding of the spectrum of neuropsychological outcomes of pediatric CA survivors and the complex relationship between standardized caregiver-reported functional outcome measures incorporated in clinical trials and performance-based neuropsychological assessments..
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U2 - 10.1001/jamaneurol.2018.2628
DO - 10.1001/jamaneurol.2018.2628
M3 - Article
C2 - 30242322
AN - SCOPUS:85053658773
VL - 75
SP - 1502
EP - 1510
JO - JAMA Neurology
JF - JAMA Neurology
SN - 2168-6149
IS - 12
ER -