Kabbani Mohamed S, Alsumih Norah A, Alsadun Sarah A, Hamadah Hussam K
Section of Pediatric Cardiac Intensive Care, Department of Cardiac Sciences, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi ArabiaSaudi Arabia.
King Saud bin Abdulaziz University for Health Sciences, College of Medicine, Riyadh, Saudi ArabiaSaudi Arabia.
J Saudi Heart Assoc. 2019 Oct;31(4):161-169. doi: 10.1016/j.jsha.2019.05.035. Epub 2019 Jun 6.
Children who suffer cardiopulmonary arrest (CPA) after cardiac surgery frequently survive with return of spontaneous circulation. However, their neurodevelopmental outcomes and performance are still unclear. The aim of this study is to evaluate the midterm neurodevelopmental outcome and overall performance of children who survived CPA following cardiac surgery.
In this cohort study, we followed-up children who received cardiopulmonary resuscitation (CPR) post cardiac surgery during 2012-2013. We assessed their 5-year survival, functional, and neurodevelopmental outcomes using two performance scales: Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC). Both scales ranged from 1 for normal to 6 for brain death/death. We compared CPR group with a matching group (1:1) that had similar characteristics and conditions but no CPR.
Out of 758 postoperative cardiac children, 15 (2%) children had 19 episodes of CPA. Their median age was 10 months (0.5-168). Survival rates were 12/15 (80%) on hospital discharge and 10/15 (66%) after 5 years. Among 12 survivors, two patients (17%) scored 6, one (8%) scored 4, five (42%) scored 2, and four (33%) scored 1 on both PCPC and POPC. The median PCPC and POPC scores were [2, (interquartile range: 1-6) and 1, (interquartile range: 1-3, = 0.018] for CPR and matching group, respectively. Regression analysis identifies duration of CPR, number of CPR session, and late-occurring CPA as risk factors for poor outcome.
Two-thirds of children requiring CPR post cardiac surgery survived after 5 years. Their neurodevelopmental and functional evaluation demonstrated worse outcome in comparison with their matching cases. CPR duration, number of CPA events, and late CPA were risk factors for poor outcome. Rehabilitation and special education programs might be needed for these groups of children with special needs.
心脏手术后发生心肺骤停（CPA）的儿童经心肺复苏后常能恢复自主循环而存活。然而，他们的神经发育结局和表现仍不明确。本研究旨在评估心脏手术后心肺骤停存活儿童的中期神经发育结局和整体表现。
在这项队列研究中，我们对2012年至2013年期间心脏手术后接受心肺复苏（CPR）的儿童进行了随访。我们使用两种表现量表评估他们的5年生存率、功能和神经发育结局：小儿脑功能表现分类（PCPC）和小儿整体表现分类（POPC）。两种量表的评分范围均为1（正常）至6（脑死亡/死亡）。我们将心肺复苏组与一个匹配组（1:1）进行比较，匹配组具有相似的特征和情况，但未接受心肺复苏。
在758例心脏手术后儿童中，15例（2%）儿童发生了19次心肺骤停事件。他们的中位年龄为10个月（0.5 - 168个月）。出院时生存率为12/15（80%），5年后为10/15（66%）。在12名幸存者中，两名患者（17%）在PCPC和POPC量表上均得分为6分，一名（8%）得分为4分，五名（42%）得分为2分，四名（33%）得分为1分。心肺复苏组和匹配组的PCPC和POPC量表中位得分分别为[2，（四分位间距：1 - 6）]和[1，（四分位间距：1 - 3），P = 0.018]。回归分析确定心肺复苏持续时间、心肺复苏次数和迟发性心肺骤停是预后不良的危险因素。
心脏手术后需要心肺复苏的儿童中有三分之二在5年后存活。与匹配病例相比，他们的神经发育和功能评估显示结局较差。心肺复苏持续时间、心肺骤停事件次数和迟发性心肺骤停是预后不良的危险因素。对于这些有特殊需求的儿童群体，可能需要康复和特殊教育项目。
