Early Clinical Predictors of Neurological Outcome in Children With Asphyxial Out-of-Hospital Cardiac Arrest Treated With Therapeutic Hypothermia

Abstract

The aim of the current study was to identify early clinical predictors of neurologic outcome in children with asphyxial out-of-hospital cardiac arrest (OHCA) treated with therapeutic hypothermia. Methods: The present retrospective cohort study of comatose children treated with therapeutic hypothermia or normothermia after asphyxial OHCA was conducted between January 2010 and June 2018. All children aged between 1 month and 18 years of age, with a history of at least 3 min of chest compressions were eligible for inclusion. Their 6-month neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) score and early clinical predictors were determined. Results: A total of 100 patients met the eligibility criteria for the study. Sixty-four (64%) of the children were male, and the mean age of participants was 4.59 ± 5.45 years. Forty (40%) of the children had underlying disorders. The overall 1-month survival rate was 36%. Only 12 (12%) of the patients had favorable outcomes (PCPC ≤ 2). Thirty-four (34%) of the 100 children were receiving therapeutic hypothermia. In the univariate analysis, an initial lactate level of ≤80 mg/dL, a Glasgow coma scale (GCS) score of 5-8, a GCS motor score ≥4 and a present pupil reflex before therapeutic hypothermia, were significantly associated with favorable 6-month neurological outcomes. However, after the multivariate logistic analysis, only initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with favorable 6-month neurological outcomes. Lin et al. Early Predictor of Pediatric Asphyxial OHCA Conclusion: Initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with 6-month favorable neurological outcomes in pediatric asphyxial OHCA patients who were treated with therapeutic hypothermia. Therefore, these early clinical predictors could be helpful to facilitate future clinical research in children with asphyxial OHCA treated with therapeutic hypothermia.

Epileptiform Discharge and Electrographic Seizures during the Hypothermia Phase as Predictors of Rewarming Seizures in Children after Resuscitation

“…Out-of-hospital cardiac arrest was defined as patients in whom chest compressions were initiated before arriving at the hospital, and in-hospital cardiac arrest was defined as patients in whom chest compressions were initiated in the emergency department or other hospital setting [ 19 , 20 ]. Asphyxial aetiologies were defined as resuscitation secondary to acute respiratory failure after evaluating all available data, and cardiac aetiologies were defined as resuscitation secondary to shockable rhythm, such as ventricular tachycardia or ventricular fibrillation [ 19 , 20 , 21 , 22 ]. Rewarming seizures were defined as seizures during the rewarming phase.…”

“…The inclusion criteria were as follows: a: (1) age from 1 month to 18 years; (2) duration of cardiac arrest at least 3 minutes and ROSC after resuscitation; (3) comatose status (Glasgow Coma Scale ≤8) after ROSC; (4) received therapeutic hypothermia; and (5) received continuous EEG monitoring [ 19 , 20 , 21 , 22 ]. Patients were excluded if they met any of the following criteria: (1) age > 18 years; (2) did not receive continuous EEG monitoring or intermittent routine EEG; (3) not in a coma after resuscitation (Glasgow Coma Scale (GCS) > 8); and (4) hemodynamic instability refractory to intensive care and died within 72 h. All patients received therapeutic hypothermia within 6 h of resuscitation [ 19 , 20 , 21 , 22 ]. This study was approved by the Chang Gung Memorial Hospital Institutional Review Board (IRB numbers: 201600360B0D001 and 201900302B0).…”

“…The primary outcome was the presence or absence of rewarming seizures. The secondary outcomes were duration of hospitalization, 1-month mortality, and neurological outcomes, which were assessed using Pediatric Cerebral Performance Category (PCPC) scores in the children who survived for 6 months after the events or in those who died during follow-up [ 19 , 20 , 21 , 22 , 25 ]. PCPC scores measure the degree of cognitive function and are recorded as 1 to 6, where 1 is normal, 2 indicates mild disability, 3 indicates moderate disability, 4 indicates severe disability, 5 indicates coma or vegetative state, and 6 indicates brain death.…”

“…PCPC scores measure the degree of cognitive function and are recorded as 1 to 6, where 1 is normal, 2 indicates mild disability, 3 indicates moderate disability, 4 indicates severe disability, 5 indicates coma or vegetative state, and 6 indicates brain death. Neurological outcomes were dichotomized as either a favorable prognosis (PCPC ≤ 2) or unfavorable prognosis (PCPC ≥ 3 or a change from baseline ≥ 1) [ 19 , 20 , 21 , 22 , 25 ]. In addition, time intervals from arrest to starting therapeutic hypothermia, from starting therapeutic hypothermia to continuous EEG monitoring placement, from arrest to continuous EEG monitoring placement, and from rewarming to the onset of rewarming seizures were also recorded.…”

Resuscitation for Cardiac Arrest and Postcardiac Arrest Care

“…Recently, AHA revised the golden guidelines for cardiac arrest resuscitation and postcardiac arrest care on January 2, 2018 [5]. Several leading journals also recently discussed how to increase the quality and outcome in the postcardiac arrest care (including strategic application of ECPR and hypothermia in treating pediatric or traumatic patients), thus making this topic hot and timely [1,4,6,7]. e updated knowledge globally guides the treatment strategies of critical and emergency care.…”