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Resuscitation. 2017 Jun;115:178-184. doi: 10.1016/j.resuscitation.2017.03.007. Epub 2017 Mar 6.

Pediatric cardiac arrest due to drowning and other respiratory etiologies: Neurobehavioral outcomes in initially comatose children.

Author information

1
Kennedy Krieger Institute, United States; Johns Hopkins University, United States. Electronic address: slomine@kennedykrieger.org.
2
Children's Hospital of Philadelphia, United States.
3
Kennedy Krieger Institute, United States; Johns Hopkins University, United States.
4
University of Michigan, United States.
5
University of Utah, United States.
6
Children's Medical Center of Dallas and University of Texas Southwestern Medical Center, United States.
7
Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, United States.
8
Loma Linda University, United States.

Abstract

AIM:

To describe the 1-year neurobehavioral outcome of survivors of cardiac arrest secondary to drowning, compared with other respiratory etiologies, in children enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial.

METHODS:

Exploratory analysis of survivors (ages 1-18 years) who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation (ROC). Participants recruited from 27 pediatric intensive care units in North America received targeted temperature management [therapeutic hypothermia (33°C) or therapeutic normothermia (36.8°C)] within 6h of ROC. Neurobehavioral outcomes included 1-year Vineland Adaptive Behavior Scales, Second Edition (VABS-II) total and domain scores and age-appropriate cognitive performance measures (Mullen Scales of Early Learning or Wechsler Abbreviated Scale of Intelligence).

RESULTS:

Sixty-six children with a respiratory etiology of cardiac arrest survived for 1-year; 60/66 had broadly normal premorbid functioning (VABS-II≥70). Follow up was obtained on 59/60 (30 with drowning etiology). VABS-II composite and domain scores declined significantly from premorbid scores in drowning and non-drowning groups (p<0.001), although declines were less pronounced for the drowning group. Seventy-two percent of children had well below average cognitive functioning at 1-year. Younger age, fewer doses of epinephrine, and drowning etiology were associated with better VABS-II composite scores. Demographic variables and treatment with hypothermia did not influence neurobehavioral outcomes.

CONCLUSIONS:

Risks for poor neurobehavioral outcomes were high for children who were comatose after out-of-hospital cardiac arrest due to respiratory etiologies; survivors of drowning had better outcomes than those with other respiratory etiologies.

KEYWORDS:

Cardiac arrest; Cognition; Drowning; Functional outcome; Pediatrics; Respiratory arrest; Therapeutic hypothermia

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