College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States.
College of Medicine, Department of Pediatrics, Pediatric Research Hub, University of Florida, United States.
Resuscitation. 2023 Apr;185:109727. doi: 10.1016/j.resuscitation.2023.109727. Epub 2023 Feb 9.
Out-of-hospital cardiac arrest (OHCA) in pediatric patients is associated with high rates of mortality and neurologic injury, with no definitive evidence-based method to predict outcomes available. A prognostic scoring tool for adults, The Brain Death After Cardiac Arrest (BDCA) score, was recently developed and validated. We aimed to validate this score in pediatric patients.
Retrospective cohort study of pediatric patients admitted to 5 PICUs after OHCA between 2011 and 2021. We extracted BDCA score elements for those who survived at least 24 hours but died as a result of their OHCA. We assessed score discrimination for the definitive outcome of brain death. Subgroup analysis was performed for infants < 12mo versus children ≥ 12mo, those who likely had brain death but had withdrawal of life sustaining therapy (WLST) prior to declaration, and by etiology and duration of arrest.
389 subjects were identified across 5 institutions, with 282 meeting inclusion criteria. 169 (59.9%) were formally declared brain dead; 58 (20.6%) had findings consistent with brain death but had withdrawal of life sustaining therapies prior to completion of formal declaration. Area under the receiver operating characteristic curve for the age ≥ 12mo cohort was 0.82 [95% CI 0.75, 0.90], which mirrored the adult subject AUCs of 0.82 [0.77, 0.86] and 0.81 [0.76, 0.86] in the development and validation cohorts. Scores demonstrated worse discrimination in the infant cohort (AUC = 0.61).
The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.
院外心脏骤停（OHCA）在儿科患者中与高死亡率和神经损伤相关，目前尚无明确的基于证据的方法来预测预后。最近开发并验证了一种用于成人的预后评分工具，即心脏骤停后脑死亡（BDCA）评分。我们旨在验证该评分在儿科患者中的应用。
回顾性队列研究纳入了 2011 年至 2021 年间在 5 个 PICUs 接受 OHCA 治疗后至少存活 24 小时但最终因 OHCA 死亡的儿科患者。我们提取了那些存活但在正式宣布脑死亡前已停止生命支持治疗（WLST）的患者的 BDCA 评分要素。我们评估了评分对脑死亡这一明确结局的区分能力。进行了亚组分析，包括<12 个月的婴儿与≥12 个月的儿童、那些可能已经脑死亡但在正式宣布前已停止 WLST 的患者，以及根据病因和停搏时间进行的亚组分析。
共 5 家机构纳入了 389 名患者，其中 282 名符合纳入标准。169 名（59.9%）患者被正式宣布脑死亡；58 名（20.6%）患者的检查结果符合脑死亡，但在正式宣布前已停止 WLST。≥12 个月龄队列的受试者工作特征曲线下面积为 0.82 [95%置信区间 0.75, 0.90]，与开发和验证队列中成人患者的 AUC（分别为 0.82 [0.77, 0.86]和 0.81 [0.76, 0.86]）相似。该评分在婴儿队列中的区分能力较差（AUC=0.61）。
BDCA 评分在 OHCA 后≥12 个月的儿童中具有一定的预测价值，可与现有的多模态预后评估方法结合使用。
