NEUROlogical Prognosis After Cardiac Arrest in Kids (NEUROPACK) study: protocol for a prospective multicentre clinical prediction model derivation and validation study in children after cardiac arrest

Abstract

IntroductionCurrently, we are unable to accurately predict mortality or neurological morbidity following resuscitation after paediatric out of hospital (OHCA) or in-hospital (IHCA) cardiac arrest. A clinical prediction model may improve communication with parents and families and risk stratification of patients for appropriate postcardiac arrest care. This study aims to the derive and validate a clinical prediction model to predict, within 1 hour of admission to the paediatric intensive care unit (PICU), neurodevelopmental outcome at 3 months after paediatric cardiac arrest.Methods and analysisA prospective study of children (age: >24 hours and <16 years), admitted to 1 of the 24 participating PICUs in the UK and Ireland, following an OHCA or IHCA. Patients are included if requiring more than 1 min of cardiopulmonary resuscitation and mechanical ventilation at PICU admission Children who had cardiac arrests in PICU or neonatal intensive care unit will be excluded. Candidate variables will be identified from data submitted to the Paediatric Intensive Care Audit Network registry. Primary outcome is neurodevelopmental status, assessed at 3 months by telephone interview using the Vineland Adaptive Behavioural Score II questionnaire. A clinical prediction model will be derived using logistic regression with model performance and accuracy assessment. External validation will be performed using the Therapeutic Hypothermia After Paediatric Cardiac Arrest trial dataset. We aim to identify 370 patients, with successful consent and follow-up of 150 patients. Patient inclusion started 1 January 2018 and inclusion will continue over 18 months.Ethics and disseminationEthical review of this protocol was completed by 27 September 2017 at the Wales Research Ethics Committee 5, 17/WA/0306. The results of this study will be published in peer-reviewed journals and presented in conferences.Trial registration numberNCT03574025.

Transitions from short to long-term outcomes in pediatric critical care: considerations for clinical practice

“…Understanding trajectories of recovery will assist us in planning for the optimal timing of interventions to minimize or mitigate PICS-p. There are numerous studies and clinical services currently underway which are already addressing some of these gaps (164)(165)(166)(167)(168)(169)(170)(171)(172). The results of these and others, will only help to further our understanding and progress the care of children and their families following critical illness.…”

Mortality and Timing of Withdrawal of Life-Sustaining Therapies After Out-of-Hospital Cardiac Arrest: Two-Center Retrospective Pediatric Cohort Study*

“…Accurate prognostication in these such patients is challenging given the limited number of studies, especially in comparison to the literature in adult patients. These challenges have been highlighted in two articles (3, 4), and fortunately, pediatric-specific studies on prognostication after cardiac arrest are ongoing (5). In adults, prognostication after cardiac arrest should be delayed to at least 72 hours from the time of return of spontaneous circulation (ROSC), as delayed awakening from coma can occur (6, 7).…”