Slomine Beth S, Silverstein Faye S, Christensen James R, Holubkov Richard, Page Kent, Dean J Michael, Moler Frank W
Departments of Neuropsychology and Departments of Psychiatry and Behavioral Sciences, Physical Medicine and Rehabilitation, and
Departments of Pediatrics and Neurology, University of Michigan, Ann Arbor, Michigan; and.
Pediatrics. 2016 Apr;137(4). doi: 10.1542/peds.2015-3412. Epub 2016 Mar 3.
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).
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.
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.
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.
本研究调查了院外心脏骤停（OH-CA）后存活、复苏后昏迷并参与一项评估目标温度管理至低温（33.0°C）或正常体温（36.8°C）的临床试验（儿科院外心脏骤停后治疗性低温[THAPCA-OH]；NCT00878644）的儿童12个月时的神经行为结局。
OH-CA后不久（基于OH-CA前的功能状况），由照料者根据《温兰德适应行为量表第二版》（VABS-II）的回答评估基线功能；基线功能大致正常（VABS-II≥70）的儿童纳入THAPCA-OH主要结局研究。12个月后再次完成VABS-II评估。然后，完成面对面的认知评估。分析评估了随访时VABS-II综合、领域和子领域得分的变化以及认知功能。
295名入组儿童中有96名在12个月时存活；96名中有87名基线功能大致正常（VABS-II≥70）。对85/87名儿童进行了随访。85名中有42名在12个月时VABS-II≥70。基线和12个月随访之间，VABS-II综合、领域和子领域得分显著下降（P<0.001）。年龄较大的儿童下降幅度最大。大多数儿童的认知功能远低于平均水平。心脏骤停时年龄较大和基线VABS-II得分较高可预测神经行为功能下降幅度更大。低温治疗不影响神经行为结局。
这是探索复苏后昏迷的OH-CA存活儿童长期神经行为结局的最大规模研究。结果显示，1年后幸存者在多个功能领域存在显著的神经行为疾病，这基于照料者报告和客观认知测量表现。
