Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome*

Meert, Kathleen L.; Telford, Russell; Holubkov, Richard; Slomine, Beth S.; Christensen, James R.; Dean, J. Michael; Moler, Frank W.

doi:10.1097/pcc.0000000000000969

Cited by 73 publications

(66 citation statements)

References 34 publications

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“…Better outcome following drowning relative to other OHCA etiologies has been previously reported. (4, 5) While previous reports cannot be directly compared to our population, as we only examined survivors, it is possible that those with certain respiratory etiologies (such as asthma) had a significant period of hypoxia due to respiratory distress prior to OHCA and therefore may have incurred a more severe hypoxic insult.…”

Section: Discussionmentioning

confidence: 99%

“…(4) Among respiratory etiologies, drowning was associated with better outcomes. (5) Similarly, in an observational cohort, children with drowning etiologies were more likely to survive to hospital discharge compared to all other OHCA etiologies. (6) This cohort included children with lower risk for poor neurological outcome than those enrolled in the THAPCA-OH trial; all children with ≥ 1 minute of chest compressions were included (versus ≥ 2 minutes with coma after ROC in THAPCA-OH).…”

Section: Introductionmentioning

confidence: 96%

“…(4, 5) Hypothermia did not confer significant outcome benefit in comparison with normothermia and there was a high rate of culture-proven bacterial infection in both groups. (4) Among respiratory etiologies, drowning was associated with better outcomes.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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 ≥2 minutes, 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 6 hours 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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 96%

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

et al. 2017

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“…Favorable neurobehavioral outcome at 1 year post-arrest, defined as VABS-II composite score >70, was present in 27/138 (20%) subjects in the hypothermia group and 15/112 (12%) subject in the normothermia group (67). Risk factors for poor long-term neurobehavioral function were acute life threatening event/sudden unexpected infant death, respiratory causes of arrest other than drowning, unknown causes of arrest, and duration of chest compressions >30 minutes (68). There are significant ongoing efforts to optimize emergency medical systems of care and therapies aimed at improving outcomes after pediatric out-of-hospital cardiac arrest.…”

Section: Neurologic Outcomes Following Picu Carementioning

confidence: 99%

Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

Caprarola

Kudchadkar

Bembea

2017

Curr Treat Options Peds

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Purpose of review With increasing survival of children requiring admission to pediatric intensive care units (PICU), neurodevelopmental outcomes of these patients are an area of increased attention. Our goal was to systematically review recently published literature on neurologic outcomes of PICU patients. Recent Findings Decline in neurofunctional status occurs in 3%–20% of children requiring PICU care. This proportion varies based on primary diagnosis and severity of illness, with children admitted for primary neurologic diagnosis, children who suffer cardiac arrest or who require invasive interventions during the PICU admission, having worse outcomes. Recent research focuses on early identification and treatment of modifiable risk factors for unfavorable outcomes, and on long-term follow-up that moves beyond global cognitive outcomes and is increasingly including tests assessing multidimensional aspects of neurodevelopment. Summary The pediatric critical care research community has shifted focus from survival to survival with favorable neurologic outcomes of children admitted to the PICU.

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“…Each year 1.2 million newborns die in asphyxia [1][2][3][4]. In newborns the prognosis in sudden cardiac arrest is poor and neurological sequelae are severe [5,6]. Moreover, in newborns whose heart rate is < 60 bpm despite stimulation and ventilation with positive pressure for 30 s, deep acidosis is likely to develop, which may lead to myocardial dysfunction and reduced contractility.…”

Section: Introductionmentioning

confidence: 99%

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

et al. 2018

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A b s t r a c tBackground: Early bystander cardiopulmonary resuscitation (CPR) for cardiac arrest is crucial in the chain of survival. Cardiac arrest in infants is rare, but CPR is also performed in severe bradycardia. European Resuscitation Council and American Heart Association guidelines recommend continuing CPR until the heart muscle is sufficiently oxygenated and regains sufficient contractility and function. The most common and recommended CPR techniques that can be applied in newborns are the two-finger technique and two-thumb technique. Aim:We sought to assess the quality of CPR performed in newborns with the two-finger technique depending on the position of the rescuer during resuscitation. Methods:This was a prospective, randomised, crossover, simulated study. It involved 93 nurses who were required to perform a two-minute CPR using the two-finger technique in three scenarios: (A) with the newborn lying on the floor; (B) on a table; and (C) with the newborn on the rescuer's forearm. The Newborn Tory ® S2210 manikin was used to simulate a neonatal patient in cardiac arrest. The following parameters were measured: chest compression (CC) depth, CC rate, no-flow time, percentage of full release, ventilation rate, and ventilation volume, as well as the number of effective compressions and effective ventilations.Results: Statistical analysis showed significant differences in CC rates between scenarios A and B (p < 0.001) and between scenarios B and C (p = 0.002). Significant differences were also observed between the median CC depth. The median percentage of no-flow-fraction was the highest for scenario A (55%), followed by scenario B (48%), and scenario C (46%). There were significant differences between the values of no-flow-fraction between scenarios A and B (p < 0.001), and between scenarios A and C (p < 0.001). The percentage of chest full releases for scenarios A, B, and C amounted to 94%, 1%, and 92%, respectively. Significant differences in the number of effective CCs between scenarios A and B (p < 0.001) as well as B and C (p < 0.001) were revealed. The median ventilation rate was highest for scenario B (13 × min ). The highest tidal volume was obtained in scenario A (27 mL), and the lowest in scenario C (26 mL). The most effective CPR was performed when resuscitation was carried out on the rescuer's forearm. Conclusions:The quality of CCs in newborns depends on the location of the patient and the rescuer. The optimal form of resuscitation of newborns is resuscitation on the rescuer's forearm.

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Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome*

Cited by 73 publications

References 34 publications

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

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

Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

Which position should we take during newborn resuscitation? A prospective, randomised, multicentre simulation trial

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