TY - JOUR
T1 - One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation
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.
N1 - Funding Information:
Supported by the National Heart, Lung, and Blood Institute (NHLBI) grants HL094345 (to Dr Moler) and HL094339 (to Dr Dean). Support in part from the following federal planning grants contributed to the planning of the THAPCA Trials: HD044955 (to Dr Moler) and HD050531 (to Dr Moler). Additional in part support was from the following research networks: Pediatric Emergency Care Applied Research Network (PECARN) from cooperative agreements U03MC00001 , U03MC00003 , U03MC00006 , U03MC00007 , and U03MC00008 ; and the Collaborative Pediatric Critical Care Research Network (CPCCRN) from cooperative agreements U10HD500009 , U10HD050096 , U10HD049981 , U10HD049945 , U10HD049983 , U10HD050012 , and U01HD049934 . Site support was from P30HD040677, UL1TR000003UL1, RR 024986, and UL1 TR 000433. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. Please see Appendix for a full list of acknowledgments.
Funding Information:
Supported by the National Heart, Lung, and Blood Institute (NHLBI) grants HL094345 (to Dr Moler) and HL094339 (to Dr Dean). Support in part from the following federal planning grants contributed to the planning of the THAPCA Trials: HD044955 (to Dr Moler) and HD050531 (to Dr Moler). Additional in part support was from the following research networks: Pediatric Emergency Care Applied Research Network (PECARN) from cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008; and the Collaborative Pediatric Critical Care Research Network (CPCCRN) from cooperative agreements U10HD500009, U10HD050096, U10HD049981, U10HD049945, U10HD049983, U10HD050012, and U01HD049934. Site support was from P30HD040677, UL1TR000003UL1, RR 024986, and UL1 TR 000433. This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or the National Institutes of Health. Please see Appendix for a full list of acknowledgments.
Publisher Copyright:
© 2019 The Society of Thoracic Surgeons
PY - 2019/5
Y1 - 2019/5
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85063088188&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2018.11.028
DO - 10.1016/j.athoracsur.2018.11.028
M3 - Article
C2 - 30557540
AN - SCOPUS:85063088188
VL - 107
SP - 1441
EP - 1446
JO - The Annals of Thoracic Surgery
JF - The Annals of Thoracic Surgery
SN - 0003-4975
IS - 5
ER -