A majority of pediatric survivors of cardiac arrest, who were considered comatose and initially believed to have favorable outcomes, are at risk for long-term neuropsychological deficits, according to study findings published in JAMA Neurology.
Study investigators administered the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) to 160 pediatric survivors of cardiac arrest (age 48 hours to 18 years; interquartile range [IQR] 2.5 [95% CI, 1.3-6.1] years) for assessment of neurobehavioral functioning before cardiac arrest and changes in functioning after cardiac event. Participants were originally included if they had received chest compressions for at least 2 minutes and were comatose and needed mechanical ventilation after the return of circulation. To evaluate neuropsychological functioning, the researchers also used the Mullen Scales of Early Learning (Mullen) for patients younger than 6 years of age, the Wechsler Abbreviated Scale of Intelligence (WASI), and various measures of attention, executive functioning, memory, and processing speed for children 6 years of age or older.
At one year after cardiac arrest, favorable outcomes were attributed in 114 (71.2%) patients as demonstrated by a VABS-II ≥70. In patients 6 years of age or older (n=41), scores on the WASI full-scale IQ and the majority of other neuropsychological assessments were lower than a normal reference group of patients up to age 5 years 8 months (at least P <.05). In the cardiac arrest survivor group, impairments as determined by the included neuropsychological measures were between 7% and 61%.
The investigators observed a correlation between global cognitive and VABS-II scores, particularly in younger children (Mullen, r =0.69-0.87) whereas moderate correlations were found for global cognition and VABS-II in children 6 years of age or older (WASI, r =0.21-0.54). Approximately 25% of children with favorable outcomes according to the VABS-II had impairment on global cognition, whereas 85.7% of older children demonstrated selective neuropsychological deficits.
Limitations of the study included the small patient cohort and the lack of data on variables that may have influenced neuropsychological outcomes.
Findings from this small trial “provide clinicians with a greater understanding of the spectrum of neuropsychological outcomes of survivors of pediatric CA and of the complex relationship between standardized functional outcome measures used in clinical trials and performance-based cognitive outcomes.”
Slomine BS, Silverstein FS, Christensen JR, et al. Neuropsychological outcomes of children 1 year after pediatric cardiac arrest: secondary analysis of 2 randomized clinical trials [published online September 17, 2018]. JAMA Neurol. doi:10.1001/jamaneurol.2018.2628