Rebecca Ichord1, Faye S Silverstein2, Beth S Slomine2, Russell Telford2, James Christensen2, Richard Holubkov2, J Michael Dean2, Frank W Moler2. 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.
RCT Entities:
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.
Authors: Akira Nishisaki; Joseph Sullivan; Bernhard Steger; Carey R Bayer; Dennis Dlugos; Richard Lin; Rebecca Ichord; Mark A Helfaer; Vinay Nadkarni Journal: Pediatr Crit Care Med Date: 2007-01 Impact factor: 3.624
Authors: Frank W Moler; Kathleen Meert; Amy E Donaldson; Vinay Nadkarni; Richard J Brilli; Heidi J Dalton; Robert S B Clark; Donald H Shaffner; Charles L Schleien; Kimberly Statler; Kelly S Tieves; Richard Hackbarth; Robert Pretzlaff; Elise W van der Jagt; Fiona Levy; Lynn Hernan; Faye S Silverstein; J Michael Dean Journal: Crit Care Med Date: 2009-07 Impact factor: 7.598
Authors: Faye S Silverstein; Beth S Slomine; James Christensen; Richard Holubkov; Kent Page; J Michael Dean; Frank W Moler Journal: Crit Care Med Date: 2016-12 Impact factor: 7.598
Authors: A Zaritsky; V Nadkarni; M F Hazinski; G Foltin; L Quan; J Wright; D Fiser; D Zideman; P O'Malley; L Chameides Journal: Circulation Date: 1995-10-01 Impact factor: 29.690
Authors: Beth S Slomine; Faye S Silverstein; James R Christensen; Richard Holubkov; Russell Telford; J Michael Dean; Frank W Moler Journal: Resuscitation Date: 2018-01-03 Impact factor: 6.251
Authors: Frank W Moler; Faye S Silverstein; Richard Holubkov; Beth S Slomine; James R Christensen; Vinay M Nadkarni; Kathleen L Meert; Amy E Clark; Brittan Browning; Victoria L Pemberton; Kent Page; Seetha Shankaran; Jamie S Hutchison; Christopher J L Newth; Kimberly S Bennett; John T Berger; Alexis Topjian; Jose A Pineda; Joshua D Koch; Charles L Schleien; Heidi J Dalton; George Ofori-Amanfo; Denise M Goodman; Ericka L Fink; Patrick McQuillen; Jerry J Zimmerman; Neal J Thomas; Elise W van der Jagt; Melissa B Porter; Michael T Meyer; Rick Harrison; Nga Pham; Adam J Schwarz; Jeffrey E Nowak; Jeffrey Alten; Derek S Wheeler; Utpal S Bhalala; Karen Lidsky; Eric Lloyd; Mudit Mathur; Samir Shah; Theodore Wu; Andreas A Theodorou; Ronald C Sanders; J Michael Dean Journal: N Engl J Med Date: 2015-04-25 Impact factor: 91.245
Authors: Alyssa E Smith; Alex P Ganninger; Ali Y Mian; Stuart H Friess; Rejean M Guerriero; Kristin P Guilliams Journal: Resuscitation Date: 2022-02-25 Impact factor: 5.262
Authors: Katri Typpo; R Scott Watson; Tellen D Bennett; Reid W D Farris; Michael C Spaeder; Nancy J Petersen Journal: Pediatr Crit Care Med Date: 2019-10 Impact factor: 3.624
Authors: Marianne R Gildea; Frank W Moler; Kent Page; Kathleen Meert; Richard Holubkov; J Michael Dean; James R Christensen; Beth S Slomine Journal: Pediatr Crit Care Med Date: 2020-01 Impact factor: 3.624
Authors: Kathleen Meert; Beth S Slomine; Faye S Silverstein; James Christensen; Rebecca Ichord; Russell Telford; Richard Holubkov; J Michael Dean; Frank W Moler Journal: Resuscitation Date: 2019-02-25 Impact factor: 5.262
Authors: Ryan W Morgan; Matthew P Kirschen; Todd J Kilbaugh; Robert M Sutton; Alexis A Topjian Journal: JAMA Pediatr Date: 2021-03-01 Impact factor: 16.193
Authors: Mioara D Manole; Marcus J A Hook; Melissa A Nicholas; Brittany P Nelson; Adanna C Liu; Quinn C Stezoski; Andrew P Rowley; Jeffrey P Cheng; Henry Alexander; Eleni H Moschonas; Corina O Bondi; Anthony E Kline Journal: Exp Neurol Date: 2020-11-02 Impact factor: 5.330
Authors: Matthew P Kirschen; Daniel J Licht; Jennifer Faerber; Antara Mondal; Kathryn Graham; Madeline Winters; Ramani Balu; Ramon Diaz-Arrastia; Robert A Berg; Alexis Topjian; Arastoo Vossough Journal: Neurology Date: 2020-11-18 Impact factor: 9.910
Authors: Kate F Kernan; Rachel P Berger; Robert S B Clark; R Scott Watson; Derek C Angus; Ashok Panigrahy; Clifton W Callaway; Michael J Bell; Patrick M Kochanek; Ericka L Fink; Dennis W Simon Journal: Resuscitation Date: 2021-07-14 Impact factor: 5.262