AI Article Synopsis
- The study aimed to standardize the assessment of neurologic outcomes for children who survived 12 months after undergoing therapeutic hypothermia for cardiac arrest.
- Two trials involved children who remained comatose after cardiac arrest, comparing outcomes of those treated with hypothermia versus normothermia, revealing no significant differences in overall survival with favorable neurobehavioral outcomes.
- The Pediatric Resuscitation after Cardiac Arrest (PRCA) scoring method effectively categorized neurologic impairments, showing a strong correlation with established measures of cognitive and behavioral outcomes, highlighting factors that contribute to poorer results.
Article Abstract
Objective: To implement a standardized approach to characterize neurologic outcomes among 12-month survivors in the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trials.
Methods: Two multicenter trials enrolled children age 48 hours to 18 years who remained comatose after cardiac arrest (CA) occurring out-of-hospital (THAPCA-OH, NCT00878644) or in-hospital (THAPCA-IH, NCT00880087); patients were randomized to therapeutic hypothermia or therapeutic normothermia. The primary outcome, survival with favorable 12-month neurobehavioral outcome (Vineland Adaptive Behavior Scales [VABS-II]), did not differ between treatment groups in either trial. Neurologists examined 181 12-month survivors, described findings using the novel semi-quantitative Pediatric Resuscitation after Cardiac Arrest (PRCA) form, and rated findings in 6 domains; scores ranged from 0 (no deficits) to 21 (maximal deficits). PRCA scores were compared with 12-month VABS-II scores and cognitive scores.
Results: Neurologic outcome PRCA scores were classified as no/minimal impairment, PRCA 0-3, 81/179 (45%); mild impairment, PRCA 4-7, 24/179 (13%); moderate impairment, PRCA 8-11, 15/179 (8%); severe impairment, PRCA 12-16, 20/179 (11%); profound impairment, PRCA 17-21, 39/179 (21%) (2/181 incomplete). VABS-II scores correlated strongly with PRCA category ( = -0.88, < 0.0001, Pearson correlation coefficient) and cognitive scores ( = -0.72, < 0.0001). Factors associated with poor outcomes included out-of-hospital CA, seizure recognition in the early postarrest period, and poor neurologic status at hospital discharge.
Conclusion: The PRCA provides a robust method for depicting neurologic outcomes after acute encephalopathy caused by CA in children. It provides a global semiquantitative rating of neurologic impairment and domain-specific impairment. The strong correlation with well-established neurobehavioral outcome measures supports its validity over a broad age range and wide spectrum of outcomes.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053110 | PMC |
| http://dx.doi.org/10.1212/WNL.0000000000005773 | DOI Listing |
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