Slomine BS, et al. - Researchers performed secondary analysis of cardiac arrest (CA) survivors enrolled in the Therapeutic Hypothermia After Pediatric Cardiac Arrest In-Hospital (THAPCA-IH) and Out-of-Hospital (THAPCA-OH) trials, to describe their neuropsychological outcomes. They also compare the results with the primary outcome measure for these trials. Although 71.2% of the survivors had favorable caregiver-rated outcomes 1 year later, the survivors displayed significant performance-based neuropsychological deficits across measures.

Methods

• Participants of this secondary analysis comprised 222 CA survivors, aged 1 to 18 years who received chest compressions for 2 minutes or more, remained comatose and required mechanical ventilation after return of circulation.
• These participants were enrolled in targeted temperature-management trials from 41 pediatric intensive care units.
• Collection of data was done from September 3, 2009, to February 3, 2016, and analysis was done from March 10, 2017, to April 20, 2018.
• Pre-CA functioning within 24 hours after enrollment was evaluated using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II), a standardized measure of neurobehavioral functioning based on caregiver report (age-corrected mean [SD] scores = 100 [15]); VABS-II<70 indicated significant developmental delays; completion of VABS-II and neuropsychological testing was done 1 year after CA.
• The Mullen Scales of Early Learning (Mullen) was used for neuropsychological testing in children younger than 6 years; neuropsychological testing in older children was done determining the Wechsler Abbreviated Scale of Intelligence (WASI) and neuropsychological measures of attention, memory, processing speed, and executive functioning.

Results

• Neuropsychological testing was completed by 160 participants [96 (60.0%) were male; the median (interquartile range [IQR]) age was 2.5 years (1.3-6.1 years)].
• Of these, 96 (60.0%) were white, 41 (25.6%) were black, and 23 (14.4%) were of other/unknown race; 343 (21.2%) were Hispanic or Latino; 119 (74.4%) were non-Hispanic or Latino; and 7 (4.4%) were of unknown ethnicity.
• Researchers classified 114 participants (71.2%) as having favorable outcomes (VABS-II ≥70).
• The participants displayed impairments (>2 SD below the mean for age) ranging from 7% to 61% across neuropsychological measures.
• Younger children displayed strong correlations (Mullen, r = 0.69-0.87) between global cognitive and VABS-II scores but older children showed moderate correlations (r = 0.21-0.54 for the WASI).
• Global cognitive impairment was evident in 25.2% and selective neuropsychological deficits were noted in 30 of 35 older children (85.7%) among the 111 children with favorable outcomes on VABS-II.