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Extracorporeal Cardiopulmonary Resuscitation

One-Year Survival and Neurobehavioral Outcome Among Infants and Children With In-Hospital Cardiac Arrest*

Meert, Kathleen L., MD, FCCM1,2; Guerguerian, Anne-Marie, MD, PhD3,4; Barbaro, Ryan, MD5; Slomine, Beth S., PhD6,7; Christensen, James R., MD6,7; Berger, John, MD8; Topjian, Alexis, MD9; Bembea, Melania, MD, MPH, PhD7; Tabbutt, Sarah, MD, PhD10; Fink, Ericka L., MD, MS11; Schwartz, Steven M., MD, FRCPC, FAHA3,4; Nadkarni, Vinay M., MD, FCCM9; Telford, Russell, MAS12; Dean, J. Michael, MD, MBA, FCCM12; Moler, Frank W., MD, MS, FCCM5 for the Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) Trial Investigators

doi: 10.1097/CCM.0000000000003545
Pediatric Critical Care
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Objective: To describe neurobehavioral outcomes and investigate factors associated with survival and survival with good neurobehavioral outcome 1 year after in-hospital cardiac arrest for children who received extracorporeal cardiopulmonary resuscitation.

Design: Secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital trial.

Setting: Thirty-seven PICUs in the United States, Canada, and the United Kingdom.

Patients: Children (n = 147) resuscitated with extracorporeal cardiopulmonary resuscitation following in-hospital cardiac arrest.

Interventions: Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition, at prearrest baseline and 12 months postarrest. Norms for Vineland Adaptive Behavior Scales, Second Edition, are 100 (mean) ± 15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival, 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points from baseline, and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70.

Measurements and Main Results: Of 147 children receiving extracorporeal cardiopulmonary resuscitation, 125 (85.0%) had a preexisting cardiac condition, 75 (51.0%) were postcardiac surgery, and 84 (57.1%) were less than 1 year old. Duration of chest compressions was greater than 30 minutes for 114 (77.5%). Sixty-one (41.5%) survived to 12 months, 32 (22.1%) survived to 12 months with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points from baseline, and 39 (30.5%) survived to 12 months with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70. On multivariable analyses, open-chest cardiac massage was independently associated with greater 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points and greater 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70. Higher minimum postarrest lactate and preexisting gastrointestinal conditions were independently associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, decreased by less than or equal to 15 points and lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition, greater than or equal to 70.

Conclusions: About one third of children survived with good neurobehavioral outcome 1 year after receiving extracorporeal cardiopulmonary resuscitation for in-hospital arrest. Open-chest cardiac massage and minimum postarrest lactate were associated with survival with good neurobehavioral outcome at 1 year.

1Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

2Wayne State University, Detroit, MI.

3Departments of Critical Care Medicine and Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.

4University of Toronto, Toronto, ON, Canada.

5Department of Pediatrics, University of Michigan, Ann Arbor, MI.

6Departments of Physical Medicine and Rehabilitation and Neuropsychology, Kennedy Krieger Institute, Baltimore, MD.

7Johns Hopkins University, Baltimore, MD.

8Department of Pediatrics, Children’s National Health System, Washington, DC.

9Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA.

10Department of Pediatrics, Benioff Children’s Hospital, San Francisco, CA.

11Department of Critical Care Medicine and Pediatrics, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA.

12Department of Pediatrics, University of Utah, Salt Lake City, UT.

*See also p. 476.

This work is solely the responsibility of the authors and does not necessarily represent the official views of the National Heart, Lung, and Blood Institute or National Institutes of Health.

The Hypothermia after Pediatric Cardiac Arrest (THAPCA) Trial Investigators are listed in the Acknowledgments.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the National Heart, Lung, and Blood Institute grants HL094345 (to Dr. Moler) and HL094339 (to Dr. Dean). Supported, in part, from the following federal planning grants contributed to the planning of the Therapeutic Hypothermia after Pediatric Cardiac Arrest Trials: HD044955 and HD050531 (to Dr. Moler). Additional, in part, support from the following research networks: Pediatric Emergency Care Applied Research Network from cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008; and the Collaborative Pediatric Critical Care Research Network from cooperative agreements U10HD500009, U10HD050096, U10HD049981, U10HD049945, U10HD049983, U10HD050012, and U01HD049934. Site support from P30HD040677, UL1TR000003UL1, RR 024986, and UL1 TR 000433.

Drs. Meert, Guerguerian, Slomine, Berger, Topjian, Fink, and Moler’s institutions received funding from the National Institutes of Health (NIH). Drs. Meert, Guerguerian, Barbaro, Slomine, Christensen, Berger, Topjian, Fink, Schwartz, Telford, Dean, and Moler received support for article research from the NIH. Dr. Barbaro’s institution received funding from National Heart, Lungs, and Blood Institute (NHLBI) grant HL094345, and he disclosed that he is the Extracorporeal Life Support Organization Registry Chair. Dr. Slomine received funding from the American Psychological Association. Drs. Christensen, Schwartz, and Telford’s institutions received funding from the NHLBI. Dr. Berger’s institution also received funding from the Association for Pediatric Pulmonary Hypertension and Actelion. Dr. Schwartz received funding from Novartis AG (consultation regarding serelaxin for treatment of pediatric heart failure; unrelated to the work). Dr. Dean’s institution received funding from the National Institute for Child Health and Human Development. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators are listed in the Acknowledgments.

For information regarding this article, E-mail: kmeert@med.wayne.edu

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