Neurobehavioural outcomes in children after In-Hospital cardiac arrest

Research output: Contribution to journalArticlepeer-review

Authors

  • THAPCA Trial Investigators
  • B. S. Slomine
  • F. S. Silverstein
  • J. R. Christensen
  • R. Holubkov
  • R. Telford
  • F. W. Moler
  • Barney Scholefield

Colleges, School and Institutes

Abstract

Aim: Children who remain comatose after in-hospital cardiac arrest (IH-CA) resuscitation are at risk for poor neurological outcome. We report results of detailed neurobehavioural testing in paediatric IH-CA survivors, initially comatose after return of circulation, and enrolled in THAPCA-IH, a clinical trial that evaluated two targeted temperature management interventions (hypothermia, 33.0 °C or normothermia, 36.8 °C; NCT00880087).

Methods: Children, aged 2 days to <18 years, were enrolled in THAPCA-IH from 2009 to 2015; primary trial outcome (survival with favorable neurobehavioural outcome) did not differ between groups. Pre-IH-CA neurobehavioural functioning, measured with the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) was evaluated soon after enrollment; this report includes only children with broadly normal pre-IH-CA scores (VABS-II composite scores ≥70; 269 enrolled). VABS-II was re-administered 3 and 12 months later. Cognitive testing was completed at 12 months.

Results: Follow-ups were obtained on 125 of 135 eligible one-year survivors. Seventy-seven percent (96/125) had VABS-II scores ≥70 at 12 months; cognitive composites were ≥2SD of mean in 59%. VABS-II composite, domain, and most subdomain scores declined between pre-IH-CA and 3-month, and pre-IH-CA and 12-month assessments (composite means declined about 1 SD at 3 and 12 months, p < 0.005); 3 and 12-month scores were strongly correlated (r = 0.72, p < 0.001)

Conclusions: In paediatric IH-CA survivors at high risk for unfavorable outcomes, the majority demonstrated significant declines in neurobehavioural functioning, across multiple functional domains, with similar functioning at 3 and 12 months. About three-quarters attained VABS-II functional performance composite scores within the broadly normal range.

Bibliographic note

1873-1570 Slomine, Beth S Silverstein, Faye S Christensen, James R Holubkov, Richard Telford, Russell Dean, J Michael Moler, Frank W Therapeutic Hypothermia after Paediatric Cardiac Arrest (THAPCA) Trial Investigators UL1 TR000433/TR/NCATS NIH HHS/United States R21 HD044955/HD/NICHD NIH HHS/United States U54 HD079123/HD/NICHD NIH HHS/United States R34 HD050531/HD/NICHD NIH HHS/United States U01 HL094339/HL/NHLBI NIH HHS/United States U10 HD050012/HD/NICHD NIH HHS/United States U10 HD050009/HD/NICHD NIH HHS/United States U10 HD049945/HD/NICHD NIH HHS/United States P30 HD040677/HD/NICHD NIH HHS/United States P30 HD062171/HD/NICHD NIH HHS/United States KL2 TR000434/TR/NCATS NIH HHS/United States U10 HD049981/HD/NICHD NIH HHS/United States U10 HD050096/HD/NICHD NIH HHS/United States UL1 TR000003/TR/NCATS NIH HHS/United States U01 HL094345/HL/NHLBI NIH HHS/United States U10 HD049983/HD/NICHD NIH HHS/United States UL1 TR002240/TR/NCATS NIH HHS/United States U01 HD049934/HD/NICHD NIH HHS/United States UL1 RR024986/RR/NCRR NIH HHS/United States KL2 RR024987/RR/NCRR NIH HHS/United States Journal Article Research Support, N.I.H., Extramural Ireland Resuscitation. 2018 Mar;124:80-89. doi: 10.1016/j.resuscitation.2018.01.002. Epub 2018 Jan 3.

Details

Original languageEnglish
Pages (from-to)80-89
Number of pages10
JournalResuscitation
Volume124
Early online date3 Jan 2018
Publication statusPublished - Mar 2018

Keywords

  • Cardiac arrest, In-hospital cardiac arrest, Pediatrics, Outcome, Cognition, Neurobehavioral