Early Clinical Predictors of Neurological Outcome in Children With Asphyxial Out-of-Hospital Cardiac Arrest Treated With Therapeutic Hypothermia

Abstract

Aim: The aim of the current study was to identify early clinical predictors of neurologic outcome in children with asphyxial out-of-hospital cardiac arrest (OHCA) treated with therapeutic hypothermia. Methods: The present retrospective cohort study of comatose children treated with therapeutic hypothermia or normothermia after asphyxial OHCA was conducted between January 2010 and June 2018. All children aged between 1 month and 18 years of age, with a history of at least 3 min of chest compressions were eligible for inclusion. Their 6-month neurological outcomes were evaluated using the Pediatric Cerebral Performance Category (PCPC) score and early clinical predictors were determined. Results: A total of 100 patients met the eligibility criteria for the study. Sixty-four (64%) of the children were male, and the mean age of participants was 4.59 ± 5.45 years. Forty (40%) of the children had underlying disorders. The overall 1-month survival rate was 36%. Only 12 (12%) of the patients had favorable outcomes (PCPC ≤ 2). Thirty-four (34%) of the 100 children were receiving therapeutic hypothermia. In the univariate analysis, an initial lactate level of ≤ 80 mg/dL, a Glasgow coma scale (GCS) score of 5-8, a GCS motor score ≥4 and a present pupil reflex before therapeutic hypothermia, were significantly associated with favorable 6-month neurological outcomes. However, after the multivariate logistic analysis, only initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with favorable 6-month neurological outcomes. Conclusion: Initial serum lactate level and GCS before therapeutic hypothermia were significantly associated with 6-month favorable neurological outcomes in pediatric asphyxial OHCA patients who were treated with therapeutic hypothermia. Therefore, these early clinical predictors could be helpful to facilitate future clinical research in children with asphyxial OHCA treated with therapeutic hypothermia.

Keywords: asphyxial; early clinical predictor; out-of-hospital cardiac arrest; pediatric; therapeutic hypothermia.

Figure 1

A total of 135 patients with OHCA were identified. 100 asphyxial OHCA comatose patients were enrolled, including 36 patients who survival more than 1 month and 64 patients who died within 1 month. The overall 1-month survival rate was 36%. The patients with 6-month neurological outcomes included those who died during the follow-up period. Eight (23.5%) of the thirty-four patients had favorable outcome (PCPC ≤ 2) in therapeutic hypothermia group and 4 (6.1%) of the 66 patients had favorable outcome (PCPC ≤ 2) in normothermia group. (OHCA, out-of-hospital cardiac arrest; PCPC, pediatric cerebral performance category; VT, Ventricular tachycardia; CHD, congenital heart disease; ECMO, Extracorporeal Membrane Oxygenation).

Figure 2

ROC curves and the AUC of the ROC curves and cut-off points for initial serum lactate level. The AUC of the ROC and cut-off points showed that initial serum lactate level had good discriminative power in predicting favorable 6-month neurological outcomes in therapeutic hypothermia group (AUC = 0.865, cut-off point 80 mg/dL) (A) and in normothermia group (AUC = 0.886, cut-off point 48.8 mg/dL) (B). (AUC, area under the curve; ROC, receiver operating characteristic).