Neurologic outcome of pediatric survivors of cardiac arrest

Introduction: There are 17 studies which report neurologic outcome in 150 children who survive until discharge from the hospital after cardiac arrest. The reported neurologic outcome is highly variable, in part because of the small sample size in individual studies. We gathered a large number of pediatric survivors in a single report to determine the factors that predict a neurologic deficit persisting until hospital discharge (permanent deficit). Methods: The records of 86 children, ages 0-19 years, who survived to hospital discharge after cardiac arrest were analyzed using chi square analysis, the Kruskal-Wallis test, and a multiple logistic regression model. Results: Of the 86 patients, 56 (65%) returned to their pre-arrest neurologic status, 6 (7%) had a transient neurologic deficit which resolved in the hospital, and 24 (28%) developed a permanent neurologic deficit. Analysis of factors associated with the cardiac arrest or resuscitation that were predictive of a permanent neurologic deficit revealed: Univariate predictors of permanent deficit Arrest location p=0.047 Interval between arrest and CPR p=0.02 Hospital CPR duration p=0.004 Asystole p=0.01 Glasgow Coma Score at 24 hours p=0.0001 Initial PaO₂<50 mmHg p=0.02 Multiple logistic regression predictors of permanent deficit Initial PaO₂<50 mmHg Odds Ratio 27.9, 95% CI 1.0-776. p=0.05 Conclusions: Like adults, the majority of children who survive cardiac arrest have no new neurologic deficits (72%). When adjusted for simultaneous effect of significant univariate predictors, the multiple logistic regression model reveals that children with hypoxemia (PaO₂ <50mmHg) on the initial blood gas are 27.9 times more likely to suffer permanent neurologic deficit.