One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation

Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators

Research output: Contribution to journalArticle

Abstract

Background: Limited data exist about neurobehavioral outcomes of children treated with open-chest cardiopulmonary resuscitation (CPR). Our objective was to describe neurobehavioral outcomes 1 year after arrest among children who received open-chest CPR during in-hospital cardiac arrest and to explore factors associated with 1-year survival and survival with good neurobehavioral outcome. Methods: The study is a secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital Trial. Fifty-six children who received open-chest CPR for in-hospital cardiac arrest were included. Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline before arrest and 12 months after arrest. Norms for VABS-II are 100 ± 15 points. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by no more than 15 points from baseline, and 12-month survival with VABS-II of 70 or more points. Results: Of 56 children receiving open-chest CPR, 49 (88%) were after cardiac surgery and 43 (77%) were younger than 1 year. Forty-four children (79%) were cannulated for extracorporeal membrane oxygenation (ECMO) during CPR or within 6 hours of return of spontaneous circulation. Thirty-three children (59%) survived to 12 months, 22 (41%) survived to 12 months with VABS-II decreased by no more than 15 points from baseline, and of the children with baseline VABS-II of 70 or more points 23 (51%) survived to 12 months with VABS-II of 70 or more points. On multivariable analyses, use of ECMO, renal replacement therapy, and higher maximum international normalized ratio were independently associated with lower 12-month survival with VABS-II of 70 or more points. Conclusions: Approximately one-half of children survived with good neurobehavioral outcome 1 year after open-chest CPR for in-hospital cardiac arrest. Use of ECMO and postarrest renal or hepatic dysfunction may be associated with worse neurobehavioral outcomes.

Original languageEnglish (US)
JournalAnnals of Thoracic Surgery
DOIs
StatePublished - Jan 1 2019

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Psychological Adaptation
Cardiopulmonary Resuscitation
Nervous System
Thorax
Pediatrics
Heart Arrest
Extracorporeal Membrane Oxygenation
Induced Hypothermia
International Normalized Ratio
Renal Replacement Therapy
Thoracic Surgery
Kidney
Liver

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation. / Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators.

In: Annals of Thoracic Surgery, 01.01.2019.

Research output: Contribution to journalArticle

Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators. / One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation. In: Annals of Thoracic Surgery. 2019.
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abstract = "Background: Limited data exist about neurobehavioral outcomes of children treated with open-chest cardiopulmonary resuscitation (CPR). Our objective was to describe neurobehavioral outcomes 1 year after arrest among children who received open-chest CPR during in-hospital cardiac arrest and to explore factors associated with 1-year survival and survival with good neurobehavioral outcome. Methods: The study is a secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital Trial. Fifty-six children who received open-chest CPR for in-hospital cardiac arrest were included. Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline before arrest and 12 months after arrest. Norms for VABS-II are 100 ± 15 points. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by no more than 15 points from baseline, and 12-month survival with VABS-II of 70 or more points. Results: Of 56 children receiving open-chest CPR, 49 (88{\%}) were after cardiac surgery and 43 (77{\%}) were younger than 1 year. Forty-four children (79{\%}) were cannulated for extracorporeal membrane oxygenation (ECMO) during CPR or within 6 hours of return of spontaneous circulation. Thirty-three children (59{\%}) survived to 12 months, 22 (41{\%}) survived to 12 months with VABS-II decreased by no more than 15 points from baseline, and of the children with baseline VABS-II of 70 or more points 23 (51{\%}) survived to 12 months with VABS-II of 70 or more points. On multivariable analyses, use of ECMO, renal replacement therapy, and higher maximum international normalized ratio were independently associated with lower 12-month survival with VABS-II of 70 or more points. Conclusions: Approximately one-half of children survived with good neurobehavioral outcome 1 year after open-chest CPR for in-hospital cardiac arrest. Use of ECMO and postarrest renal or hepatic dysfunction may be associated with worse neurobehavioral outcomes.",
author = "{Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators} and Meert, {Kathleen L.} and Ralph Delius and Slomine, {Beth S} and Christensen, {James R} and Kent Page and Richard Holubkov and Dean, {J. Michael} and Moler, {Frank W.}",
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AU - Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators

AU - Meert, Kathleen L.

AU - Delius, Ralph

AU - Slomine, Beth S

AU - Christensen, James R

AU - Page, Kent

AU - Holubkov, Richard

AU - Dean, J. Michael

AU - Moler, Frank W.

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