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Pediatrics. 2016 Apr;137(4). pii: e20153412. doi: 10.1542/peds.2015-3412. Epub 2016 Mar 3.

Neurobehavioral Outcomes in Children After Out-of-Hospital Cardiac Arrest.

Author information

1
Departments of Neuropsychology and Departments of Psychiatry and Behavioral Sciences, Physical Medicine and Rehabilitation, and slomine@kennedykrieger.org.
2
Departments of Pediatrics and Neurology, University of Michigan, Ann Arbor, Michigan; and.
3
Physical Medicine and Rehabilitation, and Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Baltimore, Maryland; Pediatrics, John Hopkins University, Baltimore, Maryland;
4
Department of Pediatrics, University of Utah, Salt Lake City, Utah.
5
Departments of Pediatrics and.

Abstract

OBJECTIVE:

This study examined 12-month neurobehavioral outcomes in children who survived out-of-hospital cardiac arrest (OH-CA), were comatose after resuscitation, and were enrolled in a clinical trial to evaluate targeted temperature management to hypothermia (33.0°C) or normothermia (36.8°C) (Therapeutic Hypothermia after Pediatric Cardiac Arrest, Out-of-Hopsital [THAPCA-OH]; NCT00878644).

METHODS:

Baseline functioning was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II) soon after OH-CA (based on functioning before OH-CA); children with broadly normal baseline functioning (VABS-II ≥70) were included in the THAPCA-OH primary outcome. VABS-II was completed again 12 months later. Then, face-to-face cognitive evaluations were completed. Analyses evaluated changes in VABS-II composite, domain, and subdomain scores and cognitive functioning at follow-up.

RESULTS:

Ninety-six of 295 enrolled children were alive at 12 months; 87 of 96 had broadly normal baseline functioning (VABS-II ≥70). Follow-up was obtained on 85/87. Forty-two of 85 had VABS-II ≥70 at 12 months. VABS-II composite, domain, and subdomain scores declined significantly between baseline and 12-month follow-up (P < .001). Declines were greatest in older children. Most children displayed well below average cognitive functioning. Older age at cardiac arrest and higher baseline VABS-II scores were predictive of greater decline in neurobehavioral function. Treatment with hypothermia did not influence neurobehavioral outcomes.

CONCLUSIONS:

This is the largest study exploring long-term neurobehavioral outcomes in children surviving OH-CA who were comatose after resuscitation. Results revealed significant neurobehavioral morbidity across multiple functional domains, based both on caregiver reports and performance on objective cognitive measures, in survivors 1 year later.

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