Temperature Management and Health-Related Quality of Life in Children 3 Years After Cardiac Arrest.

OBJECTIVES: Therapeutic hypothermia minimizes neuronal injury in animal models of hypoxic-ischemic encephalopathy with greater effect when used sooner after the insult. Clinical trials generally showed limited benefit but are difficult to perform in a timely manner. In this clinical study, we evaluated the association between the use of hypothermia (or not) and health-related quality of life among survivors of pediatric cardiac arrest as well as overall mortality. DESIGN: Single-center, retrospectively identified cohort with prospective assessment of health-related quality of life. SETTING: PICU of a pediatric hospital. PATIENTS: Children with either out-of-hospital or in-hospital cardiac arrest from January 2012 to December 2017. INTERVENTIONS: Patients were assigned into two groups: those who received therapeutic hypothermia at less than or equal to 35°C and those who did not receive therapeutic hypothermia but who had normothermia targeted (36-36.5°C). The primary outcome was health-related quality of life assessment and the secondary outcome was PICU mortality. MEASUREMENTS AND MAIN RESULTS: We studied 239 children, 112 (47%) in the therapeutic hypothermia group. The median (interquartile range) of lowest temperature reached in the 48 hours post cardiac arrest in the therapeutic hypothermia group was 33°C (32.6-33.6°C) compared with 35.4°C (34.7-36.2°C) in the no therapeutic hypothermia group (p < 0.001). At follow-up, 152 (64%) were alive and health-related quality of life assessments were completed in 128. Use of therapeutic hypothermia was associated with higher lactate and lower pH at baseline. After regression adjustment, therapeutic hypothermia (as opposed to no therapeutic hypothermia) was associated with higher physical (mean difference, 15.8; 95% CI, 3.5-27.9) and psychosocial scores (13.6 [5.8-21.5]). These observations remained even when patients with a temperature greater than 37.5°C were excluded. We failed to find an association between therapeutic hypothermia and lower mortality. CONCLUSIONS: Out-of-hospital or in-hospital cardiac arrest treated with therapeutic hypothermia was associated with higher health-related quality of life scores despite having association with higher lactate and lower pH after resuscitation. We failed to identify an association between use of therapeutic hypothermia and lower mortality.

Trends in the incidence and outcome of paediatric out-of-hospital cardiac arrest: A 17-year observational study.

BACKGROUND: System-based improvements to the chain of survival have yielded increases in survival from out-of-hospital cardiac arrest (OHCA) in adults. Comparatively little is known about the long-term trends in incidence and survival following paediatric OHCA. METHODS: Between 2000 and 2016, we included children aged ≤16 years who suffered a non-traumatic OHCA in the state of Victoria, Australia. Trends in incidence and unadjusted outcomes were assessed using linear regression and a non-parametric test for trend. Multivariable logistic regression with multiple imputation was used to identify arrest factors associated with event survival and survival to hospital discharge. RESULTS: Of the 1301 paediatric OHCA events attended by emergency medical services (EMS), 948 (72.9%) received an attempted resuscitation. The overall incidence of EMS-attended and EMS-treated events was 6.7 and 4.9 cases per 100,000 person-years, with no significant changes in trend. Although the proportion of cases with OHCA identified in the call and receiving bystander CPR increased over time, EMS response times also increased. Unadjusted event survival rose from 23.3% in 2000 to 33.3% in 2016 (p trend = .007), and survival to hospital discharge rose from 9.4% to 17.7% over the same period (p trend = .04). Increases in survival to hospital discharge were largely driven by initial shockable arrests, which rose from 33.3% in 2000 to 60.0% in 2016 (p trend = .005). Survival after initial shockable arrests was higher if the first shock was delivered by either first responder or public AED compared with paramedics (83.3% vs. 40.0%, p = .04). After adjustment, the odds of event survival and survival to hospital discharge increased independent of baseline characteristics, by 7% (OR 1.07, 95% CI: 1.03, 1.11; p = .001) and 8% (OR 1.08, 95% CI: 1.01, 1.15; p = .02) per study year, respectively. CONCLUSIONS: Survival following paediatric OHCA increased in our region over a 17 year period. This was driven, in part, by improving outcomes for initial shockable arrests.

Outcomes of children admitted to intensive care after out-of-hospital cardiac arrest in Victoria, Australia.

OBJECTIVES: Paediatric out-of-hospital cardiac arrest (OHCA) is an uncommon event but is associated with high mortality and severe neurological sequelae among survivors. Most studies of paediatric OHCA are population-based, with very few reports on the cohort admitted to the paediatric intensive care unit (PICU). We sought to determine outcomes and predictors of neurologically intact survival in these children admitted to the PICU. DESIGN AND SETTING: Retrospective analysis of data prospectively collected from the PICU and emergency department (ED) databases and cross-checked with medical records and coronial reports for January 2005 to December 2014. Neurological outcome was assessed using the Paediatric Cerebral Performance Category scale. MAIN OUTCOME MEASURE: Survival with a favourable neurological outcome at hospital discharge. RESULTS: In the 10 years, 283 children presented with OHCA. After 16 study exclusions (because of cardiopulmonary resuscitation [CPR] duration < 1 min or age > 16 years), there were 121 children who died in the ED and 146 admitted to the PICU. Among the PICU cohort, hospital survival with favourable neurological outcome was 42% (60 of 143), and at 1 year after arrest it was 41% (59 of 143). The following factors were associated with the primary outcome: bystander CPR (odds ratio [OR], 4.74 [95% CI, 1.49-15.05]); cardiac aetiology (OR, 6.40 [95% CI, 1.65-24.76]); male sex (OR, 0.32 [95% CI, 0.12- 0.84]); and CPR duration: = 20 min v 0-5 min (OR, 0.05 [95% CI, 0.01-0.16]) and 6-20 min v 0-5 min (OR, 0.45 [95% CI, 0.16-1.28]). CONCLUSIONS: Bystander CPR and primary cardiac aetiology had strong associations with survival with a favourable neurological outcome after paediatric OHCA. Maximising CPR education for the community, and targeting people most likely to witness a paediatric OHCA may further improve outcomes.