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Scholefield BR, Tijssen J, Ganesan SL, Kool M, Couto TB, Topjian A, Atkins DL, Acworth J, McDevitt W, Laughlin S, Guerguerian AM. Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation 2024:110483. [PMID: 39742939 DOI: 10.1016/j.resuscitation.2024.110483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 12/19/2024] [Accepted: 12/22/2024] [Indexed: 01/04/2025]
Abstract
AIM To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest. METHODS Medline, EMBASE and Cochrane Trials databases were searched (2010-2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either 'no, mild, moderate disability or minimal change from baseline') in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool. RESULTS Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR <30% for predicting good neurological outcome with moderate (50-75%) or high (>75%) sensitivity: bilateral reactive pupillary light response within 12h; motor component ≥4 on the Glasgow Coma Scale score at 6h; bilateral somatosensory evoked potentials at 24-72h; sleep spindles, and continuous cortical activity on electroencephalography within 24h; or a normal brain MRI at 4-6d. Early (≤12h) normal lactate levels (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate <30% and low (<50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity. CONCLUSIONS Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing.
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Affiliation(s)
- Barnaby R Scholefield
- Department of Critical Care Medicine, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Neurosciences and Mental Health Program, Research Institute Toronto, ON, Canada.
| | - Janice Tijssen
- Western University, Department of Paediatrics, London, ON, Canada & Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Saptharishi Lalgudi Ganesan
- Western University, Department of Paediatrics, London, ON, Canada & Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada
| | - Mirjam Kool
- Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, UK
| | - Thomaz Bittencourt Couto
- Hospital Israelita Albert Einstein AND Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil
| | - Alexis Topjian
- The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, and and Pediatrics, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Jason Acworth
- Emergency Department, Queensland Children's Hospital, Brisbane, Australia
| | - Will McDevitt
- Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, and Institute of Cardiovascular Sciences, University of Birmingham, UK
| | - Suzanne Laughlin
- Department of Diagnostic and Interventional Radiology, Hospital for Sick Children, ON, Canada, Department of Medical Imaging, University of Toronto, ON, Canada
| | - Anne-Marie Guerguerian
- Department of Critical Care Medicine, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Neurosciences and Mental Health Program, Research Institute Toronto, ON, Canada
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Pireddu R, Ristagno G, Gianquintieri L, Bonora R, Pagliosa A, Andreassi A, Sechi GM, Signorelli C, Stirparo G. Out-of-Hospital Cardiac Arrest in the Paediatric Patient: An Observational Study in the Context of National Regulations. J Clin Med 2024; 13:3133. [PMID: 38892845 PMCID: PMC11172461 DOI: 10.3390/jcm13113133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Introduction: Cardiac arrest results in a high death rate if cardiopulmonary resuscitation and early defibrillation are not performed. Mortality is strongly linked to regulations, in terms of prevention and emergency-urgency system organization. In Italy, training of lay rescuers and the presence of defibrillators were recently made mandatory in schools. Our analysis aims to analyze Out-of-Hospital Cardiac Arrest (OHCA) events in pediatric patients (under 18 years old), to understand the epidemiology of this phenomenon and provide helpful evidence for policy-making. Methods: A retrospective observational analysis was conducted on the emergency databases of Lombardy Region, considering all pediatric OHCAs managed between 1 January 2016, and 31 December 2019. The demographics of the patients and the logistics of the events were statistically analyzed. Results: The incidence in pediatric subjects is 4.5 (95% CI 3.6-5.6) per 100,000 of the population. School buildings and sports facilities have relatively few events (1.9% and 4.4%, respectively), while 39.4% of OHCAs are preventable, being due to violent accidents or trauma, mainly occurring on the streets (23.2%). Conclusions: Limiting violent events is necessary to reduce OHCA mortality in children. Raising awareness and giving practical training to citizens is a priority in general but specifically in schools.
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Affiliation(s)
- Roberta Pireddu
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Ristagno
- Department of Medical and Surgical Pathophysiology and Transplantation, University of Milano, 20133 Milano, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20090 Milano, Italy
| | - Lorenzo Gianquintieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milano, Italy
| | - Rodolfo Bonora
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Andrea Pagliosa
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | - Aida Andreassi
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
| | | | - Carlo Signorelli
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
| | - Giuseppe Stirparo
- School of Public Health, Faculty of Medicine, University Vita-Salute San Raffaele, 20132 Milano, Italy
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), 20124 Milano, Italy
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Hunfeld M, Buysse C. Decisions Regarding Life or Death in Comatose Children After Out-of-Hospital Cardiac Arrest. Pediatr Crit Care Med 2024; 25:281-283. [PMID: 38451801 DOI: 10.1097/pcc.0000000000003436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC Sophia, Rotterdam, The Netherlands
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia, Rotterdam, The Netherlands
| | - Corinne Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia, Rotterdam, The Netherlands
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Hunfeld M, Dulfer K, Del Castillo J, Vázquez M, Buysse C. Long-term multidisciplinary follow-up programs in pediatric cardiac arrest survivors. Resusc Plus 2024; 17:100563. [PMID: 38328751 PMCID: PMC10847941 DOI: 10.1016/j.resplu.2024.100563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Long-term outcome studies after pediatric cardiac arrest (CA) are few. They require a CA registry and dedicated outcome teams. Learning about the long-term outcomes is very important for developing prognostication guidelines, improving post-cardiac care, counseling caregivers about the future of their child, and creating opportunities for therapeutic intervention studies to improve outcomes. Few PICUs worldwide provide a multidisciplinary follow-up program as routine practice at an outpatient clinic with standardized measurements, using validated instruments including neuropsychological assessments by psychologists. The primary goal of such a follow-up program should be to provide excellent care to children and their caregivers, thereby resulting in a high attendance. Pediatric psychologists, neurologists and pediatricians/pediatric intensivists should ideally be involved to screen for delayed development and psychosocial problems and offer appropriate care at the same time. Preferably, outcomes should consist of evaluation of morbidity (physical and neuropsychological), functional health and Health Related Quality Of Life (QoL) of the patient and their caregivers.
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Affiliation(s)
- M. Hunfeld
- Department of Neonatal and Pediatric Intensive Care Unit, Division of Pediatric Intensive Care Unit, Erasmus MC Children’s Hospital, Rotterdam, the Netherlands
| | - K. Dulfer
- Department of Neonatal and Pediatric Intensive Care Unit, Division of Pediatric Intensive Care Unit, Erasmus MC Children’s Hospital, Rotterdam, the Netherlands
| | - J. Del Castillo
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origen Network (RICORS-RD21/0012/0011), Spain
| | - M. Vázquez
- Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Primary Care Interventions to Prevent Maternal and Child Chronic Diseases of Perinatal and Development Origen Network (RICORS-RD21/0012/0011), Spain
| | - C.M.P. Buysse
- Department of Neonatal and Pediatric Intensive Care Unit, Division of Pediatric Intensive Care Unit, Erasmus MC Children’s Hospital, Rotterdam, the Netherlands
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Fovaeus H, Holmen J, Mandalenakis Z, Herlitz J, Rawshani A, Castellheim AG. Out-of-hospital cardiac arrest: Survival in children and young adults over 30 years, a nationwide registry-based cohort study. Resuscitation 2024; 195:110103. [PMID: 38160903 DOI: 10.1016/j.resuscitation.2023.110103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/17/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVES We studied short-term (30-day) and long-term (up to ten-year) survival among children and young adults following out-of-hospital cardiac arrest (OHCA) in Sweden over the course of the past 30 years. We also studied the causes of OHCA in children and examined predictors of survival. SETTING This was a nationwide, registry-based cohort study, using the Swedish Registry of Cardiopulmonary Resuscitation. Our study comprised a cohort of 4,804 individuals aged 0 to 30 years who suffered OHCA between 1990 and 2020, in whom cardiopulmonary resuscitation (CPR) was initiated. We stratified the study cohort to distinct age groups and time periods. RESULTS We found an increase in 30-day survival from 7% to 20% over the span of 30 years. In those under 1 year of age, survival increased from 2% to 19%. Time to CPR decreased from 14 to 2 min. The 10-year survival was high among those who survived 30 days. The etiology of cardiac arrests exhibited significant variations across different age groups but remained relatively consistent over time. Causes linked to mental illness constituted a substantial percentage of these cases. Compared to the reference period (1990-1994), the odds of survival in 2015-2020 was 3.00 (95% CI: 1.43, 6.94; p = 0.006). CONCLUSION Survival rate after OHCA in children and young adults has increased three-fold over the past 30 years. Still overall mortality is high underscoring the need for continued efforts to mitigate risk factors and optimize survival.
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Affiliation(s)
- Hannah Fovaeus
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatrics, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Johan Holmen
- Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zacharias Mandalenakis
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Medicine, Adult Congenital Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Araz Rawshani
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Albert Gyllencreutz Castellheim
- Department of Anesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Pediatric Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden
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Pin Pek P, Cheng Fan K, Eng Hock Ong M, Luo N, Østbye T, Lynn Lim S, Fuwah Ho A. Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review. Resuscitation 2023; 188:109794. [PMID: 37059353 DOI: 10.1016/j.resuscitation.2023.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE With a growing number of out-of-hospital cardiac arrest (OHCA) survivors globally, the focus of OHCA management has now broadened to survivorship. An outcome central to survivorship is health-related quality of life (HRQoL). This systematic review aimed to synthesise evidence related to the determinants of HRQoL of OHCA survivors. METHODS We systematically searched MEDLINE, Embase, and Scopus from inception to 15 August 2022 to identify studies investigating the association of at least one determinant and HRQoL in adult OHCA survivors. All articles were independently reviewed by two investigators. We abstracted data pertaining to determinants and classified them using a well-established HRQoL theoretical framework - the Wilson and Cleary (revised) model. RESULTS 31 articles assessing a total of 35 determinants were included. Determinants were classified into the five domains in the HRQoL model. 26 studies assessed determinants related to individual characteristics (n=3), 12 studied biological function (n=7), nine studied symptoms (n=3), 16 studied functioning (n=5), and 35 studied characteristics of the environment (n=17). In studies that included multivariable analyses, most reported that individual characteristics (older age, female sex), symptoms (anxiety, depression), and functioning (impaired neurocognitive function) were significantly associated with poorer HRQoL. CONCLUSIONS Individual characteristics, symptoms, and functioning played significant roles in explaining the variability in HRQoL. Significant non-modifiable determinants such as age and sex could be used to identify populations at risk of poorer HRQoL, while significant modifiable determinants such as psychological health and neurocognitive functioning could serve as targets for post-discharge screening and rehabilitation plans. PROSPERO registration number: CRD42022359303.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai Cheng Fan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Marcus Eng Hock Ong
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Truls Østbye
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fuwah Ho
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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