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Randomized Controlled Trial
. 2019 May;107(5):1441-1446.
doi: 10.1016/j.athoracsur.2018.11.028. Epub 2018 Dec 14.

One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation

Kathleen L Meert  1 , Ralph Delius  2 , Beth S Slomine  3 , James R Christensen  4 , Kent Page  5 , Richard Holubkov  5 , J Michael Dean  5 , Frank W Moler  6 ; Therapeutic Hypothermia after Pediatric Cardiac Arrest Trial Investigators
Affiliations
Randomized Controlled Trial

One-Year Survival and Neurologic Outcomes After Pediatric Open-Chest Cardiopulmonary Resuscitation

Kathleen L Meert et al. Ann Thorac Surg. 2019 May.

Abstract

Background: Limited data exist about neurobehavioral outcomes of children treated with open-chest cardiopulmonary resuscitation (CPR). Our objective was to describe neurobehavioral outcomes 1 year after arrest among children who received open-chest CPR during in-hospital cardiac arrest and to explore factors associated with 1-year survival and survival with good neurobehavioral outcome.

Methods: The study is a secondary analysis of the Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital Trial. Fifty-six children who received open-chest CPR for in-hospital cardiac arrest were included. Neurobehavioral status was assessed using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) at baseline before arrest and 12 months after arrest. Norms for VABS-II are 100 ± 15 points. Outcomes included 12-month survival, 12-month survival with VABS-II decreased by no more than 15 points from baseline, and 12-month survival with VABS-II of 70 or more points.

Results: Of 56 children receiving open-chest CPR, 49 (88%) were after cardiac surgery and 43 (77%) were younger than 1 year. Forty-four children (79%) were cannulated for extracorporeal membrane oxygenation (ECMO) during CPR or within 6 hours of return of spontaneous circulation. Thirty-three children (59%) survived to 12 months, 22 (41%) survived to 12 months with VABS-II decreased by no more than 15 points from baseline, and of the children with baseline VABS-II of 70 or more points 23 (51%) survived to 12 months with VABS-II of 70 or more points. On multivariable analyses, use of ECMO, renal replacement therapy, and higher maximum international normalized ratio were independently associated with lower 12-month survival with VABS-II of 70 or more points.

Conclusions: Approximately one-half of children survived with good neurobehavioral outcome 1 year after open-chest CPR for in-hospital cardiac arrest. Use of ECMO and postarrest renal or hepatic dysfunction may be associated with worse neurobehavioral outcomes.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier Estimates of Survival to One Year after Cardiac Arrest.
See this image and copyright information in PMC

Comment in

  • Invited Commentary.
    Hines MH. Hines MH. Ann Thorac Surg. 2019 May;107(5):1446-1447. doi: 10.1016/j.athoracsur.2018.12.017. Epub 2019 Jan 11. Ann Thorac Surg. 2019. PMID: 30641070 No abstract available.

References

    1. Society of Thoracic Surgeons Task Force on Resuscitation After Cardiac Surgery. The Society of Thoracic Surgeons expert consensus for the resuscitation of patients who arrest after cardiac surgery. Ann Thorac Surg 2017;103:1005–1020. - PubMed
    1. Twomey D, Das M, Subramanian H, Dunning J. Is internal massage superior to external massage for patients suffering a cardiac arrest after cardiac surgery? Interact CardioVasc Thorac Surg 2008;7:151–157. - PubMed
    1. Miller AC, Rosati SF, Suffredini AF, Schrump DS. A systematic review and pooled analysis of CPR-associated cardiovascular and thoracic injuries. Resuscitation 2014;85:724–731. - PMC - PubMed
    1. Bradley MJ, Bonds BW, Chang L, et al. Open chest cardiac massage offers no benefit over closed chest compressions in patients with traumatic cardiac arrest. J Trauma Acute Care Surg 2016;81:849–854. - PubMed
    1. Endo A, Shiraishi A, Otomo Y, Tomita M, Matsui H, Murata K. Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: Analysis of a nationwide trauma registry. Crit Care 2017;21:169. - PMC - PubMed

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