TY - JOUR
T1 - Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials
AU - THAPCA Trial Group
AU - Ichord, Rebecca
AU - Silverstein, Faye S.
AU - Slomine, Beth S.
AU - Telford, Russell
AU - Christensen, James
AU - Holubkov, Richard
AU - Michael Dean, J.
AU - Moler, Frank W.
N1 - Funding Information:
Primary support for the conduct of the THAPCA-OH and THAPCA-IH Trials was funding from NIH U01HL094345 (F. W.M.) and U01HL094339 (J.M.D.). Additional support from the following federal grants contributed to the planning of the THAPCA Trials: NIH, Eunice Kennedy Shriver National Institute of Child Health and Development (NICHD), Bethesda, MD; HD044955 (F.W.M.) and HD050531 (F.W.M.). In part, support was from the participation of the following research networks: Pediatric Emergency Care Applied Research Network (PECARN) from cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008, and the Collaborative Pediatric Critical Care Research Network (CPCCRN) from cooperative agreements (U10HD500009, U10HD050096, U10HD049981, U10HD049945, U10HD049983, U10HD050012, and U01HD049934). At several centers, clinical research support was supplemented by the following grants or cooperative agreements: UL1TR000003, P30HD040677, P30HD062171, U07MC09174, UL1 RR 024986, and UL1 TR 000433.
Publisher Copyright:
© 2018 American Academy of Neurology
PY - 2018/7/10
Y1 - 2018/7/10
N2 - 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 (r = −0.88, p < 0.0001, Pearson correlation coefficient) and cognitive scores (r = −0.72, p < 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.
AB - 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 (r = −0.88, p < 0.0001, Pearson correlation coefficient) and cognitive scores (r = −0.72, p < 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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U2 - 10.1212/WNL.0000000000005773
DO - 10.1212/WNL.0000000000005773
M3 - Article
C2 - 29884735
AN - SCOPUS:85055650454
SN - 0028-3878
VL - 91
SP - E123-E131
JO - Neurology
JF - Neurology
IS - 2
ER -