title: Pediatric cardiac arrest due to drowning and other respiratory etiologies: Neurobehavioral outcomes in initially comatose children.
abstract: To describe the 1-year neurobehavioral outcome of survivors of cardiac arrest secondary to drowning, compared with other respiratory etiologies, in children enrolled in the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital (THAPCA-OH) trial.
  
  
  
  Exploratory analysis of survivors (ages 1-18 years) who received chest compressions for ≥2min, were comatose, and required mechanical ventilation after return of circulation (ROC). Participants recruited from 27 pediatric intensive care units in North America received targeted temperature management [therapeutic hypothermia (33°C) or therapeutic normothermia (36.8°C)] within 6h of ROC. Neurobehavioral outcomes included 1-year Vineland Adaptive Behavior Scales, Second Edition (VABS-II) total and domain scores and age-appropriate cognitive performance measures (Mullen Scales of Early Learning or Wechsler Abbreviated Scale of Intelligence).
  
  
  
  Sixty-six children with a respiratory etiology of cardiac arrest survived for 1-year; 60/66 had broadly normal premorbid functioning (VABS-II≥70). Follow up was obtained on 59/60 (30 with drowning etiology). VABS-II composite and domain scores declined significantly from premorbid scores in drowning and non-drowning groups (p<0.001), although declines were less pronounced for the drowning group. Seventy-two percent of children had well below average cognitive functioning at 1-year. Younger age, fewer doses of epinephrine, and drowning etiology were associated with better VABS-II composite scores. Demographic variables and treatment with hypothermia did not influence neurobehavioral outcomes.
  
  
  
  Risks for poor neurobehavioral outcomes were high for children who were comatose after out-of-hospital cardiac arrest due to respiratory etiologies; survivors of drowning had better outcomes than those with other respiratory etiologies.
authors.affiliation: Kennedy Krieger Institute, United States; Johns Hopkins University, United States. Electronic address: slomine@kennedykrieger.org.
authors.forename: Beth S
authors.initials: BS
authors.lastname: Slomine
authors.affiliation: Children's Hospital of Philadelphia, United States.
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.affiliation: Kennedy Krieger Institute, United States; Johns Hopkins University, United States.
authors.forename: James R
authors.initials: JR
authors.lastname: Christensen
authors.affiliation: University of Michigan, United States.
authors.forename: Faye S
authors.initials: FS
authors.lastname: Silverstein
authors.affiliation: University of Utah, United States.
authors.forename: Russell
authors.initials: R
authors.lastname: Telford
authors.affiliation: Children's Hospital of Philadelphia, United States.
authors.forename: Alexis
authors.initials: A
authors.lastname: Topjian
authors.affiliation: Children's Medical Center of Dallas and University of Texas Southwestern Medical Center, United States.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Koch
authors.affiliation: University of Utah, United States.
authors.forename: Jill
authors.initials: J
authors.lastname: Sweney
authors.affiliation: Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, United States.
authors.forename: Ericka L
authors.initials: EL
authors.lastname: Fink
authors.affiliation: Loma Linda University, United States.
authors.forename: Mudit
authors.initials: M
authors.lastname: Mathur
authors.affiliation: University of Utah, United States.
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.affiliation: University of Utah, United States.
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.affiliation: University of Michigan, United States.
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
mesh_terms: D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D060825:Cognitive Dysfunction / Q000453:epidemiology* / Q000209:etiology; D003128:Coma / Q000209:etiology; D004332:Drowning; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D009483:Neuropsychological Tests; D058687:Out-of-Hospital Cardiac Arrest / Q000523:psychology* / Q000628:therapy; D011446:Prospective Studies; D020127:Recovery of Function; D012121:Respiration, Artificial; D012307:Risk Factors
keywords: Cardiac arrest; Cognition; Drowning; Functional outcome; Pediatrics; Respiratory arrest; Therapeutic hypothermia