Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials

Rebecca Ichord; Faye S Silverstein; Beth S Slomine; Russell Telford; James Christensen; Richard Holubkov; J Michael Dean; Frank W Moler; THAPCA Trial Group

doi:10.1212/WNL.0000000000005773

Neurologic outcomes in pediatric cardiac arrest survivors enrolled in the THAPCA trials

Neurology. 2018 Jul 10;91(2):e123-e131. doi: 10.1212/WNL.0000000000005773. Epub 2018 Jun 8.

Authors

Rebecca Ichord¹, Faye S Silverstein², Beth S Slomine², Russell Telford², James Christensen², Richard Holubkov², J Michael Dean², Frank W Moler²; THAPCA Trial Group

Collaborators

THAPCA Trial Group:
Frank W Moler, J Michael Dean, Richard Holubkov, James R Christensen, Beth S Slomine, Frank W Moler, J Michael Dean, Richard Holubkov, James R Christensen, Beth S Slomine, K Meert, J Hutchison, V Nadkarni, S Shankaran, F Silverstein, V Pemberton, C Nicholson, J Alten, S Borasino, K Hock, K Sewell, L Dure, H J Dalton, S Buttram, K Wai, A La Bell, C Bliss, M Lavoie, V Bordes-Edgar, A Theodorou, K Typpo, C Wells, J Deschenes, C Newth, S Rubin, R Bart, T Deakers, A Bhalla, B Markovitz, J DiCarlo, P Ross, C Herrington, W Wells, R Kim, V Wang, M Villa, F Fajardo, J Kwok, J Serrano, J Valentine, A Yamakawa, S Briones, S Cauley, A Briseno, C Young, M Nyc, T Rosser, J I Gold, R Engilman, A Schwarz, J Haykawa, O Vargas-Shiraishi, A Galion, M Mathur, J Newcombe, A Pinto, S Ashwal, J Pivonka-Jones, R Harrison, R Kelly, A Madikians, M Federman, M Morgan, A Yamakawa, M Nyc, S Briones, M Villa, J Kwok, J Serrano, J Valentine, T Rosser, R Engilman, J I Gold, P McQuillen, L Haeusslein, H Glass, J Hutchison, S Schwartz, A Guerguerian, K Boutis, D Clark, J Van Huyse, K Fusco, K McBain, A Krancevic, L Toller, R Gaiteiro, C Hahn, R Sananes, E Dobyns, J Albietz, T Wilson, B Wathen, T Bernard, J Dise-Lewis, N Pham, N Chanani, K Walson, J Sturm, W Mahle, M Wolf, C Stone, A Wellons, S Meisner, E Hoar, S Gentry, L Smitley, L McMaster, P Holt, B Weissman, A Alexander, R Lutfi, D Sokol, B McDonald, D Goodman, E Powell, S Shah, M Porter, J Sullivan, M Ruppe, J Berkenbosch, M Thomas, L Sears, U Bhalala, J K Lee, S Kudchadkar, D Shaffner, M Shackelford, P Melvin, R Felling, B Slomine, J R Christensen, B S Slomine, E DeMatt, M Talley, C Rodweller, K Meert, S Heidemann, J Clark, A Pawluszka, M Lulic, L Sivaswamy, F Moler, M Gaies, T Cornell, M Weber, J Reske, L Conlin, F Silverstein, M Carlson, S Warschausky, T Behnke, D Poszywak, J Nowak, H Ortega, D Milner, E Zielinski, J Pineda, M Shoykhet, S Friess, A Gazit, K Gilliams, D Jaffe, T Day, T Hicks, L Barganier, E Fish, L Toennies, P Thurst, S Blankenship, M Noetzel, K Guilliams, D White, C Schleien, N Talathoti, C Aguilar, V Hinton, E W van der Jagt, E R Taillie, E B Nazarian, L E Daugherty, C O Davis, H R Adams, G Ofori-Amanfo, K Rehder, S Wrenn, T Uhl, C Milleson, E Smith, K Gustafson, S Asbeck, W Gallentine, E Lloyd, M Hall, N Khan, J Frazier, Daniel Cohen, J Haines, K Carter, L Bird, W Lo, D Wheeler, G Geis, E Beckman, S Banschbach, K Krallman, K Lidsky, S Bergant, A Browning, N Bass, R Tangen, N J Thomas, A Shelly, J Vallati, P Carper, D Spear, A McMonagle, J Stokes, H Watts, W Trescher, C Flaherty-Craig, A Topjian, R Berg, V Nadkarni, A Zuppa, J Fitzgerald, P Meaney, M DiLiberto, C Twelves, S McGowan, M Sisko, B Park, R Ichord, K Friedman, E Fink, R Hickey, A Abraham, S Shah, K Anand, B Moore, A Nico West, M Grandberry, N Shah, A DeCrow, O King DeBerry, A Huling, J Koch, P Okada, D Miles, L Raman, M Green, E Golson, A Jones, D Kelly, T Plumb, K Van de Bruinhorst, M Dowling, P Stavinoha, A Hernandez, T Wu, C Bauerfeld, M Rodkey, H Dibrell, S Atkinson, L O'Donnell, J Eubanks, J M Dean, R Holubkov, B Browning, M Gildea, R Kuhn, A Webster, K Page, R Telford, L Herrera, J Yearley, J Burr, K S Bennett, J Sweney, R Lane, J Lilley, S Bjerregaard, K Jacobsen, A Watson, D Stephens, M DelaCruz, K Cooley, N Kwendakwema, G Jensen, R Moore, M Sweney, D Morita, R Burr, T Bennett, J Henricksen, E Hirshberg, G Larsen, M Schober, R Dixon, J Workman, J Zimmerman, J McGuire, R Farris, O Yanay, J Reid, L Smith, S Hamilton, C Greeley, C Cheng, S Gospe, C Amlie-Lefond, D Breiger, A Paolozzi, J Berger, D Wessel, M Sharron, S Basu, A Wratney, N Dean, J Reardon, E Tomanio, J Carpenter, S Swanson, T Brennan, P Glass, B Malek, M Mintz, M T Meyer, M Wakeham, S Hanson, K Murkowski, P Baines, N Shetty, A Wood, S Siner, L Walsh, B Scholefield, A Jones, T Cameron, A Mohammed Ali, K Morris, I Zafurallah, I A Top, J Menzies, S Skellett, T Thiruchelvam, A J Petros, M J Peters, D Goodacre, A Jones, J Pappachan, R Ensom, K Morton, V Pemberton

Affiliations

¹ From the Department of Neurology & Pediatrics (R.I.), Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania; University of Michigan (F.S.S., F.W.M.), Ann Arbor; Kennedy Krieger Institute and Johns Hopkins University (B.S.S., J.C.), Baltimore, MD; and University of Utah (R.T., R.H., J.M.D.), Salt Lake City. ichord@email.chop.edu.
² From the Department of Neurology & Pediatrics (R.I.), Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania; University of Michigan (F.S.S., F.W.M.), Ann Arbor; Kennedy Krieger Institute and Johns Hopkins University (B.S.S., J.C.), Baltimore, MD; and University of Utah (R.T., R.H., J.M.D.), Salt Lake City.

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 (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.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Child
Child, Preschool
Coma / complications
Coma / psychology*
Female
Humans
Hypothermia, Induced*
Infant
Male
Neurologic Examination
Neuropsychological Tests
Out-of-Hospital Cardiac Arrest / complications
Out-of-Hospital Cardiac Arrest / psychology*
Out-of-Hospital Cardiac Arrest / therapy*
Survivors / psychology*
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT00878644
ClinicalTrials.gov/NCT00880087

Abstract

Publication types

MeSH terms

Associated data

Grants and funding