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Cardiac Arrest in Children: Long-Term Health Status and Health-Related Quality of Life*

van Zellem, Lennart MD1; Utens, Elisabeth M. PhD2; Legerstee, Jeroen S. PhD2; Cransberg, Karlien MD, PhD3; Hulst, Jessie M. MD, PhD4; Tibboel, Dick MD, PhD1; Buysse, Corinne MD, PhD1

Pediatric Critical Care Medicine: October 2015 - Volume 16 - Issue 8 - p 693–702
doi: 10.1097/PCC.0000000000000452
Feature Articles

Objective: To assess long-term health status and health-related quality of life in survivors of cardiac arrest in childhood and their parents. In addition, to identify predictors of health status and health-related quality of life.

Design: This medical follow-up study involved consecutive children surviving cardiac arrest between January 2002 and December 2011, who had been admitted to the ICU. Health status was assessed with a medical interview, physical examination, and the Health Utilities Index. Health-related quality of life was assessed with the Child Health Questionnaires and Short-Form 36.

Setting: A tertiary care university children’s hospital.

Patients: Of the eligible 107 children, 57 (53%) filled out online questionnaires and 47 visited the outpatient clinic (median age, 8.7 yr; median follow-up interval, 5.6 yr).

Interventions: None.

Measurements and Main Results: Of the participants, 60% had an in-hospital cardiac arrest, 90% a nonshockable rhythm, and 50% a respiratory etiology of arrest. Mortality rate after hospital discharge was 10%. On health status, we found that 13% had long-term neurologic deficits, 34% chronic symptoms (e.g., fatigue, headache), 19% at least one sign suggestive of chronic kidney injury, and 15% needed special education. Health Utilities Index scores were significantly decreased on most utility scores and the overall Health Utilities Index mark 3 score. Compared with Dutch normative data, parent-reported health-related quality of life of cardiac arrest survivors was significantly worse on general health perception, physical role functioning, parental impact, and overall physical summary. On patient reports, no significant differences with normative data were found. Parents reported better family cohesion and better health-related quality of life for themselves on most scales. Patients’ health status, general health perceptions, and physical summary scores were significantly associated with cardiac arrest–related preexisting condition.

Conclusions: Considering the impact of cardiac arrest, the overall outcome after cardiac arrest in childhood is reasonably good. Prospective long-term outcome research in large homogeneous groups is needed.

Supplemental Digital Content is available in the text.

1Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

2Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

3Department of Pediatrics, Subdivision of Pediatric Nephrology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

4Department of Pediatric Gastroenterology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

*See also p. 772.

This work was performed at Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands.

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The authors have disclosed that they do not have any potential conflicts of interest.

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©2015The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies