title: Neurobehavioral Outcomes in Children After Out-of-Hospital Cardiac Arrest.
abstract: OBJECTIVE
  This study examined 12-month neurobehavioral outcomes in children who survived out-of-hospital cardiac arrest (OH-CA), were comatose after resuscitation, and were enrolled in a clinical trial to evaluate targeted temperature management to hypothermia (33.0°C) or normothermia (36.8°C) (Therapeutic Hypothermia after Pediatric Cardiac Arrest, Out-of-Hopsital [THAPCA-OH]; NCT00878644).
  
  
  METHODS
  Baseline functioning was assessed by caregiver responses on the Vineland Adaptive Behavior Scales-Second Edition (VABS-II) soon after OH-CA (based on functioning before OH-CA); children with broadly normal baseline functioning (VABS-II ≥70) were included in the THAPCA-OH primary outcome. VABS-II was completed again 12 months later. Then, face-to-face cognitive evaluations were completed. Analyses evaluated changes in VABS-II composite, domain, and subdomain scores and cognitive functioning at follow-up.
  
  
  RESULTS
  Ninety-six of 295 enrolled children were alive at 12 months; 87 of 96 had broadly normal baseline functioning (VABS-II ≥70). Follow-up was obtained on 85/87. Forty-two of 85 had VABS-II ≥70 at 12 months. VABS-II composite, domain, and subdomain scores declined significantly between baseline and 12-month follow-up (P < .001). Declines were greatest in older children. Most children displayed well below average cognitive functioning. Older age at cardiac arrest and higher baseline VABS-II scores were predictive of greater decline in neurobehavioral function. Treatment with hypothermia did not influence neurobehavioral outcomes.
  
  
  CONCLUSIONS
  This is the largest study exploring long-term neurobehavioral outcomes in children surviving OH-CA who were comatose after resuscitation. Results revealed significant neurobehavioral morbidity across multiple functional domains, based both on caregiver reports and performance on objective cognitive measures, in survivors 1 year later.
authors.affiliation: Departments of Neuropsychology and Departments of Psychiatry and Behavioral Sciences, Physical Medicine and Rehabilitation, and slomine@kennedykrieger.org.
authors.forename: Beth S
authors.initials: BS
authors.lastname: Slomine
authors.affiliation: Departments of Pediatrics and Neurology, University of Michigan, Ann Arbor, Michigan; and.
authors.forename: Faye S
authors.initials: FS
authors.lastname: Silverstein
authors.affiliation: Physical Medicine and Rehabilitation, and Physical Medicine and Rehabilitation, Kennedy Krieger Institute, Baltimore, Maryland; Pediatrics, John Hopkins University, Baltimore, Maryland;
authors.forename: James R
authors.initials: JR
authors.lastname: Christensen
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: Kent
authors.initials: K
authors.lastname: Page
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, Utah.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.affiliation: Departments of Pediatrics and.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
mesh_terms: D000293:Adolescent; D001077:Aptitude Tests; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology*; D003128:Coma / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D065886:Neurodevelopmental Disorders / Q000175:diagnosis / Q000209:etiology*; D009483:Neuropsychological Tests; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications* / Q000523:psychology / Q000628:therapy; D017741:Survivors / Q000523:psychology*