Longitudinal two years evaluation of neuropsychological outcome in children after out of hospital cardiac arrest

Abstract

Aim: To investigate longitudinal functional and neuropsychological outcomes 3-6 and 24 months after paediatric out-of-hospital cardiac arrest (OHCA). Further, to explore the association between pediatric cerebral performance category (PCPC) and intelligence.Methods: Prospective longitudinal single center study including children (0-17 years) with OHCA, admitted to the PICU of a tertiary care hospital between 2012 and 2017. Survivors were assessed during an outpatient multidisciplinary follow-up program 3-6 and 24 months post-OHCA. Functional and neuropsychological outcomes were assessed through interviews, neurological exam, and validated neuropsychological testing.Results: The total eligible cohort consisted of 49 paediatric OHCA survivors.The most common cause of OHCA was arrhythmia (33%). Median age at time of OHCA was 48 months, 67% were males. At 3-6 and 24 months post-OHCA, respectively 74 and 73% had a good PCPC score, defined as 1-2. Compared with normative data, OHCA children obtained worse sustained attention and processing speed scores 3-6 (n = 26) and 24 (n = 27) months post-OHCA. At 24 months, they also obtained worse intelligence, selective attention and cognitive flexibility scores. In children tested at both time-points (n = 19), no significant changes in neuropsychological outcomes were found over time. Intelligence scores did not correlate with PCPC. Conclusion:Although paediatric OHCA survivors had a good PCPC score 3-6 and 24 months post-OHCA, they obtained worse scores on important neuropsychological domains such as intelligence and executive functioning (attention and cognitive flexibility). Follow-up should continue over a longer life span in order to fully understand the long-term impact of OHCA in childhood.

Long-Term Outcomes after Non-Traumatic Out-of-Hospital Cardiac Arrest in Pediatric Patients: A Systematic Review

“…Mean age ranged from 1.5 to 6.4 years. Three studies were conducted in the United States of America [ 22 , 23 , 24 ], two were conducted in the Netherlands [ 25 , 26 ], one in Finland [ 27 ], and one in Taiwan [ 28 ]. Two studies were prospective cohort studies, and five were retrospective cohort studies.…”

“…In terms of survival beyond 1 year, only two [ 25 , 26 ] studies reported this outcome. Albrecht et al reported a survival of 95% at a median follow-up time of 26.3 months, while Hunfeld et al reported a survival of 98% at a mean follow-up time of 24 months.…”

“…In terms of survival with favorable neurological outcomes beyond 1 year, only two [ 25 , 26 ] studies reported this outcome. Albrecht et al reported that 10% of patients had a favorable neurological outcome at a median follow-up time of 3.7 years, while Hunfeld et al reported that 71% of patients had a favorable neurological outcome at a mean follow-up time of 2 years.…”

“…Four articles reported the HRQoL outcomes of pediatric OHCA patients. One [ 26 ] study was comparative, comparing the HRQoL of the long-term survivors of pediatric OHCA to the general population, while the other three [ 23 , 24 , 27 ] studies were non-comparative. The summary of the four studies is presented in Table 2 .…”

“…Hunfeld et al [ 26 ] utilized 11 instruments: Total IQ, Verbal IQ, Performance IQ, Selective Attention (STROOP ≥ 11 years), Sustained Attention (Bourdon SD ≥ 6 years), Processing Speed (≥4 years), VMI (Beery ≥ 2 years), Verbal Memory (Rey-AVLT, delayed recall ≥ 6 years), Visual Memory (ReyRecog ≥ 5 years), Cognitive Flexibility (TMTB ≥ 8 years), and BRIEF Total score (≥2 years). All neuropsychological tests were converted into Z-scores and outcomes were elicited at 3–6 months and 24 months, with good outcomes (PCPC 1–2) reported in 74 and 73% of survivors, respectively.…”