Multimodal assessment using early brain CT and blood pH improve prediction of neurologic outcomes after pediatric cardiac arrest

Yang, Donghwa; Ha, Seok Gyun; Ryoo, Eell; Choi, Jea Yeon; Kim, Hyo Jeong

doi:10.1016/j.resuscitation.2019.01.033

Cited by 16 publications

(13 citation statements)

References 29 publications

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“…In contrast, the cut-off value of 1.14 for the sGWR was consistent with the values determined in previous studies (1.08–1.28) 9 – 11 . The GWR physiologically increases with age in children 10 due to differences in the growth between gray and white matter, as gray matter develops during the first two years of life, followed by the development of the white matter 28 , 29 .…”

Section: Discussionmentioning

confidence: 99%

Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Tetsuhara

Kaku

Watanabe

et al. 2021

Sci Rep

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Predicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. Subjects were non-traumatic, out-of-hospital CA patients < 16 years of age who underwent the first head CT within 24 h in our institute from 2006 to 2018 (n = 70, median age: 4 months, range 0–163). Of the 24 patients with return of spontaneous circulation, 14 survived up to 30 days after CA. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-to-white-matter-attenuation ratio (sGWR). The 14 survivors showed higher mASPECTS values than the 56 non-survivors (p = 0.035). All 3 patients with mASPECTS scores ≥ 20 survived, while an sGWR ≥ 1.14 indicated a higher chance of survival than an sGWR < 1.14 (54.5% vs. 13.6%). Follow-up magnetic resonance imaging for survivors validated the correlation of the mASPECTS < 15 with severe brain damage. Thus, low mASPECTS scores were associated with unfavorable neurological outcomes on the Pediatric Cerebral Performance Category scale. A quantitative analysis of early head CT findings might provide clues for predicting survival of pediatric CA.

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Section: Discussionmentioning

confidence: 99%

Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Tetsuhara

Kaku

Watanabe

et al. 2021

Sci Rep

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“…28) In another study of 64 children who underwent brain CT within 24 hours of cardiac arrest, a decreased GWR and ambient cistern effacement predicted a poor outcome. 29) The study presented a GWR cutoff value of 1.08 as a poor outcome for patients aged <4 years and 1.18 for patients aged ≥4 years with 100% specificity. 29) Brain CT studies are mostly retrospective and there is inade quate evidence to determine the timing of brain CT and classify the findings for prognostication.…”

Section: Computed Tomographymentioning

confidence: 93%

“…29) The study presented a GWR cutoff value of 1.08 as a poor outcome for patients aged <4 years and 1.18 for patients aged ≥4 years with 100% specificity. 29) Brain CT studies are mostly retrospective and there is inade quate evidence to determine the timing of brain CT and classify the findings for prognostication. However, brain CT is a con venient scan that can be performed quickly and easily in the emergency room.…”

Section: Computed Tomographymentioning

confidence: 93%

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How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

Kim

2020

Clin Exp Pediatr

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The prognosis of patients who are comatose after resuscitation remains uncertain. The accurate prediction of neurological outcome is important for management decisions and coun seling. A neurological examination is an important factor for prognosti cation, but widely used sedatives alter the neurolo gical examina tion and delay the response recovery. Additional studies inclu ding electroencephalography, somatosen sory evoked potentials, brain imaging, and blood bio markers are useful for evaluating the extent of brain injury. This review aimed to assess the usefulness of and provide practical progno stic strategy for pediatric post resuscita tion pati ents. The prin ciples of prognostication are that the assessment should be delay ed until at least 72 hours after cardiac arrest and the asse ssment should be multimodal. Furthermore, multiple factors including unmeasured confoun ders in indi vidual patients should be considered when applying the prog nostication strategy.

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“…1,2 Prediction of an individual child's chance of survival and neurologic recovery is often difficult in the early postcardiac arrest (CA) period. Neurofunctional outcome studies in children who initially survive CA but remain unresponsive after return of spontaneous circulation (ROSC) are often limited by single-center design, [2][3][4][5][6][7] small sample sizes, [3][4][5] or short-term follow-up to hospital discharge. 3,4,[6][7][8] Prior studies have linked the presence of multiorgan dysfunction syndrome (MODS) with increased short-term mortality in a variety of pediatric populations.…”

Section: Introductionmentioning

confidence: 99%

Does Non-Neurologic Multiorgan Dysfunction After Out-of-Hospital Cardiac Arrest among Children Admitted in Coma Predict Outcome 1 Year Later?

Corbett

Presson

Zhang

et al. 2020

J Pediatr Intensive Care

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We investigated if non-neurologic multiorgan dysfunction syndrome (MODS) following out-of-hospital cardiac arrest (OHCA) predicts poor 12-month survival. We conducted a secondary data analysis of therapeutic hypothermia after pediatric cardiac arrest out-of-hospital randomized trial involving children who remained unconscious and intubated after OHCA (n = 237). Associations between MODS and 12-month outcomes were assessed using multivariable logistic regression. Non-neurologic MODS was present in 95% of patients and sensitive (97%; 95% confidence interval [CI]: 93–99%) for 12-month survival but had poor specificity (10%; 95% CI: 4–21%). Development of non-neurologic MODS is not helpful to predict long-term neurologic outcome or survival after OHCA.

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Multimodal assessment using early brain CT and blood pH improve prediction of neurologic outcomes after pediatric cardiac arrest

Cited by 16 publications

References 29 publications

Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

Predictive values of early head computed tomography for survival outcome after cardiac arrest in childhood: a pilot study

How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

Does Non-Neurologic Multiorgan Dysfunction After Out-of-Hospital Cardiac Arrest among Children Admitted in Coma Predict Outcome 1 Year Later?

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