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

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

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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cardiopulmonary Resuscitation
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Cognitive Dysfunction / epidemiology*
  • Cognitive Dysfunction / etiology
  • Coma / etiology
  • Drowning*
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Neuropsychological Tests
  • Out-of-Hospital Cardiac Arrest / psychology*
  • Out-of-Hospital Cardiac Arrest / therapy
  • Prospective Studies
  • Recovery of Function*
  • Respiration, Artificial
  • Risk Factors