1
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Scharink D, Hunfeld M, Albrecht M, Dulfer K, de Hoog M, van Gils A, de Jonge R, Buysse C. An 18-year, single centre, retrospective study of long-term neurological outcomes in paediatric submersion-related cardiac arrests. Resusc Plus 2024; 18:100632. [PMID: 38646092 PMCID: PMC11026833 DOI: 10.1016/j.resplu.2024.100632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
Aim Investigate long-term outcome in paediatric submersion-related cardiac arrests (CA). Methods Children (age one day-17 years) were included if admitted to the Erasmus MC Sophia Children's Hospital, after drowning with CA, between 2002 and 2019. Primary outcome was survival with favourable neurological outcome, defined as a Paediatric Cerebral Performance Category (PCPC) score of 1-3 at longest available follow-up. Secondary outcome were age-appropriate neuropsychological assessments at longest available follow-up. Results Upon hospital admission, 99 children were included (median age at time of CA 3.2 years [IQR 2.0-5.9] and 65% males). Forty children died in-hospital (no return of circulation (45%) or withdrawal of life sustaining therapies (55%)) and 4 children deceased after hospital discharge due to complications following the drowning-incident. Among survivors, with a median follow-up of 2.3 years [IQR 0.2-5.5], 47 children had favourable neurological outcome (i.e. PCPC 1-3) and 8 children unfavourable (unfavourable outcome group total n = 52, i.e. PCPC 4-5 or deceased). Twenty-six (47%) children participated in a neuropsychological assessment (median follow-up 4.0 years [IQR 2.3-8.7]). Compared with normative test data, participants obtained worse general (p = 0.008) and performance (p = 0.003) intelligence scores, processing speed (p = 0.002) and visual motor integration scores (p = 0.0012). Conclusions Although overall outcome in survivors was favourable at longest available follow-up, significant deficits in neuropsychological assessments were found. This study underlines the need for a standardized long term follow-up program as standard of care in paediatric drowning with CA.
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Affiliation(s)
- Denne Scharink
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Maayke Hunfeld
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
- Department of Paediatric Neurology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Marijn Albrecht
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Karolijn Dulfer
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Matthijs de Hoog
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Annabel van Gils
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Rogier de Jonge
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Corinne Buysse
- Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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2
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Pinto NP, Scholefield BR, Topjian AA. Pediatric cardiac arrest: A review of recovery and survivorship. Resuscitation 2024; 194:110075. [PMID: 38097105 DOI: 10.1016/j.resuscitation.2023.110075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Neethi P Pinto
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | | | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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3
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Nogueira ALM, Maciel ALDS, Querubino AC, Prado RT, Martins JR. Efficacy and Risks of Therapeutic Hypothermia after Pediatric Cardiac Arrest: A Systematic Review. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.36660/ijcs.20210246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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4
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Hordijk JA, Verbruggen SC, Buysse CM, Utens EM, Joosten KF, Dulfer K. Neurocognitive functioning and health-related quality of life of children after pediatric intensive care admission: a systematic review. Qual Life Res 2022; 31:2601-2614. [PMID: 35357629 PMCID: PMC9356943 DOI: 10.1007/s11136-022-03124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study systematically reviewed recent findings on neurocognitive functioning and health-related quality of life (HRQoL) of children after pediatric intensive care unit admission (PICU). DATA SOURCES Electronic databases searched included Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. The search was limited to studies published in the last five years (2015-2019). STUDY SELECTION Original studies assessing neurocognitive functioning or HRQoL in children who were previously admitted to the PICU were included in this systematic review. DATA EXTRACTION Of the 3649 identified studies, 299 met the inclusion criteria based on title abstract screening. After full-text screening, 75 articles were included in the qualitative data reviewing: 38 on neurocognitive functioning, 33 on HRQoL, and 4 on both outcomes. DATA SYNTHESIS Studies examining neurocognitive functioning found overall worse scores for general intellectual functioning, attention, processing speed, memory, and executive functioning. Studies investigating HRQoL found overall worse scores for both physical and psychosocial HRQoL. On the short term (≤ 12 months), most studies reported HRQoL impairments, whereas in some long-term studies HRQoL normalized. The effectiveness of the few intervention studies during and after PICU admission on long-term outcomes varied. CONCLUSIONS PICU survivors have lower scores for neurocognitive functioning and HRQoL than children from the general population. A structured follow-up program after a PICU admission is needed to identify those children and parents who are at risk. However, more research is needed into testing interventions in randomized controlled trials aiming on preventing or improving impairments in critically ill children during and after PICU admission.
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Affiliation(s)
- José A Hordijk
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Sascha C Verbruggen
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Corinne M Buysse
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Elisabeth M Utens
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Rijksstraatweg 145, 1115 AP, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands
| | - Koen F Joosten
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
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5
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Huebschmann NA, Cook NE, Murphy S, Iverson GL. Cognitive and Psychological Outcomes Following Pediatric Cardiac Arrest. Front Pediatr 2022; 10:780251. [PMID: 35223692 PMCID: PMC8865388 DOI: 10.3389/fped.2022.780251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Abstract
Cardiac arrest is a rare event in children and adolescents. Those who survive may experience a range of outcomes, from good functional recovery to severe and permanent disability. Many children experience long-term cognitive impairment, including deficits in attention, language, memory, and executive functioning. Deficits in adaptive behavior, such as motor functioning, communication, and daily living skills, have also been reported. These children have a wide range of neurological outcomes, with some experiencing specific deficits such as aphasia, apraxia, and sensorimotor deficits. Some children may experience emotional and psychological difficulties, although many do not, and more research is needed in this area. The burden of pediatric cardiac arrest on the child's family and caregivers can be substantial. This narrative review summarizes current research regarding the cognitive and psychological outcomes following pediatric cardiac arrest, identifies areas for future research, and discusses the needs of these children for rehabilitation services and academic accommodations.
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Affiliation(s)
- Nathan A Huebschmann
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,New York University Grossman School of Medicine, New York, NY, United States
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States
| | - Sarah Murphy
- Division of Pediatric Critical Care, MassGeneral Hospital for Children, Boston, MA, United States.,Department of Pediatrics, Harvard Medical School, Boston, MA, United States
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, United States.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Research Institute, Charlestown, MA, United States
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6
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Webb AC, Wheeler A, Ricci A, Foxworthy B, Hinten B, Shah N, Monroe KW, Nichols MH. Descriptive Epidemiology of Pediatric Drowning Patients Presenting to a Large Southern US Children's Hospital. South Med J 2021; 114:266-270. [PMID: 33942108 DOI: 10.14423/smj.0000000000001250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Drowning is the leading cause of death for children ages 1 to 4, and it is among the leading causes of death for children of all ages. National data show disparities in drowning risk for certain racial groups. This study aimed to describe characteristics of patients presenting after a drowning event to guide focused drowning prevention outreach efforts. METHODS This was a retrospective chart review study designed to analyze the epidemiologic and demographic characteristics of drowning-related injuries and deaths that presented to a large, urban, southern US pediatric hospital from 2016 to 2019. All patients aged 0 to 19 years were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes for drowning or submersion injuries. RESULTS One hundred sixty-two patients met the inclusion criteria for the study. Submersion injuries were most common in the 1- to 5-year-old age group. Fifty-eight percent of patients were male. The analysis of race showed that 65% of patients were White and 33% of patients were Black. Pools were the setting for 78% of drowning events. Fifty-four percent of patients received cardiopulmonary resuscitation. Sixty-four percent of patients required hospitalization after the injury. CONCLUSIONS Characteristics of drowning victims may vary significantly from national data, depending on the area involved. This finding highlights the need for assessing local data to better inform local outreach. Further research is necessary to understand why such variance exists. Drowning prevention education, tailored toward pool safety and preschool-age children, should be a focus of injury prevention efforts.
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Affiliation(s)
- Alicia C Webb
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Austin Wheeler
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Alexis Ricci
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Blake Foxworthy
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Brittany Hinten
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Nipam Shah
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Kathy W Monroe
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
| | - Michele H Nichols
- From the Department of Pediatrics, Division of Pediatric Emergency Medicine, the Department of Pediatrics, University of Alabama at Birmingham, and the University of Alabama School of Medicine, Birmingham, Alabama
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7
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Sharma S, Blagrave K, Watson SR, O’Reilly CM, Batt R, Magnuson JJ, Clemens T, Denfeld BA, Flaim G, Grinberga L, Hori Y, Laas A, Knoll LB, Straile D, Takamura N, Weyhenmeyer GA. Increased winter drownings in ice-covered regions with warmer winters. PLoS One 2020; 15:e0241222. [PMID: 33206655 PMCID: PMC7673519 DOI: 10.1371/journal.pone.0241222] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/09/2020] [Indexed: 11/21/2022] Open
Abstract
Winter activities on ice are culturally important for many countries, yet they constitute a high safety risk depending upon the stability of the ice. Because consistently cold periods are required to form stable and thick ice, warmer winters could degrade ice conditions and increase the likelihood of falling through the ice. This study provides the first large-scale assessment of winter drowning from 10 Northern Hemisphere countries. We documented over 4000 winter drowning events. Winter drownings increased exponentially in regions with warmer winters when air temperatures neared 0°C. The largest number of drownings occurred when winter air temperatures were between -5°C and 0°C, when ice is less stable, and also in regions where indigenous traditions and livelihood require extended time on ice. Rates of drowning were greatest late in the winter season when ice stability declines. Children and adults up to the age of 39 were at the highest risk of winter drownings. Beyond temperature, differences in cultures, regulations, and human behaviours can be important additional risk factors. Our findings indicate the potential for increased human mortality with warmer winter air temperatures. Incorporating drowning prevention plans would improve adaptation strategies to a changing climate.
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Affiliation(s)
- Sapna Sharma
- Department of Biology, York University, Toronto, Ontario, Canada
- * E-mail:
| | - Kevin Blagrave
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Simon R. Watson
- Department of Biology, York University, Toronto, Ontario, Canada
| | - Catherine M. O’Reilly
- Department of Geography, Geology, and The Environment, Illinois State University, Normal, Illinois, United States of America
| | - Ryan Batt
- Rutgers University, New Brunswick, New Jersey, United States of America
| | - John J. Magnuson
- Center for Limnology, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Tessa Clemens
- Drowning Prevention Research Centre Canada, Toronto, Ontario, Canada
| | - Blaize A. Denfeld
- Department of Ecology and Environmental Science, Umeå University, Umeå, Sweden
| | - Giovanna Flaim
- Department of Sustainable Agro-ecosystems and Bioresources, Research and Innovation Centre, Fondazione Edmund Mach, San Michele all'Adige, Italy
| | - Laura Grinberga
- Department of Botany, The Latvian Museum of Natural History, Riga, Latvia
| | - Yukari Hori
- Department of Physical and Environmental Sciences, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Alo Laas
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - Lesley B. Knoll
- Itasca Biological Station and Laboratories, University of Minnesota Twin Cities, Lake Itasca, Minnesota, United States of America
| | - Dietmar Straile
- Limnological Institute, University of Konstanz, Konstanz, Germany
| | - Noriko Takamura
- Lake Biwa Branch Office, Center for Environmental Biology and Ecosystem Studies, National Institute for Environmental Studies, Otsu, Shiga, Japan
| | - Gesa A. Weyhenmeyer
- Department of Ecology and Genetics/Limnology, Uppsala University, Uppsala, Sweden
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8
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Corbett KL, Presson AP, Zhang C, Xu Y, Bratton SL, Dixon RR. Does Non-Neurologic Multiorgan Dysfunction After Out-of-Hospital Cardiac Arrest among Children Admitted in Coma Predict Outcome 1 Year Later? J Pediatr Intensive Care 2020; 10:188-196. [PMID: 34395036 DOI: 10.1055/s-0040-1715850] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022] Open
Abstract
In this article, we investigated whether non-neurologic multiorgan dysfunction syndrome (MODS) following out-of-hospital cardiac arrest (OHCA) predicts poor 12-month survival. We conducted a secondary data analysis of therapeutic hypothermia after pediatric cardiac arrest out-of-hospital randomized trial involving children who remained unconscious and intubated after OHCA ( n = 237). Associations between MODS and 12-month outcomes were assessed using multivariable logistic regression. Non-neurologic MODS was present in 95% of patients and sensitive (97%; 95% confidence interval [CI]: 93-99%) for 12-month survival but had poor specificity (10%; 95% CI: 4-21%). Development of non-neurologic MODS is not helpful to predict long-term neurologic outcome or survival after OHCA.
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Affiliation(s)
- Kelly L Corbett
- Department of Pediatrics, Section of Critical Care Medicine, Dartmouth-Hitchcock Medical Center, Lebanon
| | - Angela P Presson
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, Utah, United States.,Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Chong Zhang
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Yizhe Xu
- Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City, Utah, United States
| | - Susan L Bratton
- Department of Pediatrics, Division of Critical Care Medicine, University of Utah, Salt Lake City, Utah, United States
| | - Rebecca R Dixon
- Department of Pediatrics, Washington Permanente Medical Group, Spokane, Washington, United States
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9
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Neurofilament Light Chain-It Is Not Just About Concussions. Pediatr Crit Care Med 2020; 21:685-686. [PMID: 32618861 PMCID: PMC7402359 DOI: 10.1097/pcc.0000000000002299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Williams CN, Hartman ME, Guilliams KP, Guerriero RM, Piantino JA, Bosworth CC, Leonard SS, Bradbury K, Wagner A, Hall TA. Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury. Curr Treat Options Neurol 2019; 21:49. [PMID: 31559490 DOI: 10.1007/s11940-019-0586-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Children surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury. RECENT FINDINGS Few intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneous populations. While evaluating the effects of interventions on longitudinal PICS outcomes is in its infancy, longitudinal clinical programs targeting PICS are increasing. A multidisciplinary team with inpatient and outpatient presence is necessary to deliver the holistic integrated care required to address all domains of PICS in patients and families. While PICS is increasingly recognized as a chronic problem in PICU survivors with acquired brain injury, few interventions have targeted PICS morbidities. Research is needed to improve physical, cognitive, emotional, and social outcomes in survivors and their families.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA.
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University, Portland, OR, USA.
| | - Mary E Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Rejean M Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher C Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Skyler S Leonard
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn Bradbury
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Amanda Wagner
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
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11
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Reynolds JC, Hartley T, Michiels EA, Quan L. Long-Term Survival After Drowning-Related Cardiac Arrest. J Emerg Med 2019; 57:129-139. [PMID: 31262547 DOI: 10.1016/j.jemermed.2019.05.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/26/2019] [Accepted: 05/06/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Long-term outcomes after drowning-related cardiac arrest are not well characterized. OBJECTIVE Our aims were to estimate long-term survival and identify prognostic factors in a large, population-based cohort of drowning victims with cardiac arrest. METHODS We conducted a population-based prospective cohort study (1974-1996) of Western Washington Drowning Registry (WWDR) subjects with out-of-hospital cardiac arrest and attempted professional resuscitation. The primary outcome was long-term survival through 2012. We tabulated Utstein-style exposure variables, estimated Kaplan-Meier curves, and identified prognostic factors with Cox proportional hazard modeling. RESULTS Of 2824 WWDR cases, 407 subjects (median age 17 years [interquartile range 3-33 years], 81% were male) were included. Only 54 (13%) were still alive after 1663 person-years of follow-up. Most deaths occurred after termination of initial resuscitation or during initial hospitalization. Risk of subsequent death after hospital discharge was 9.6 (95% confidence interval [CI] 5.7-15.9) per 1000 person-years. Long-term survival differed by Utstein variables (older age, illicit substance use, pre-drowning activity, submersion duration, cardiopulmonary resuscitation duration, intubation, defibrillation, and medications) and inpatient markers of illness severity (vital signs, Glasgow Coma Scale, laboratory values, shock). In adjusted analyses, older age (hazard ratio [HR] 1.01; 95% CI 1.01-1.02), epinephrine administration (HR 1.92; 95% CI 1.31-2.80), antiepileptic administration (HR 0.53; 95% CI 0.35-0.81), initial arterial pH (HR 0.49; 95% CI 0.26-0.92), and shock (HR 2.19; 95% CI 1.16-4.15) were associated with higher risk of death. CONCLUSIONS Most cases of drowning-related cardiac arrest were fatal, but survivors to hospital discharge had a low risk of subsequent death that was independently associated with older age and clinical evidence of shock.
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Affiliation(s)
- Joshua C Reynolds
- Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Thomas Hartley
- Department of Emergency Medicine, Sinai-Grace Hospital, Wayne State University, Detroit, Michigan
| | - Erica A Michiels
- Department of Emergency Medicine, Helen DeVos Children's Hospital, Grand Rapids, Michigan
| | - Linda Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
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12
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Fukuda T, Ohashi-Fukuda N, Hayashida K, Kukita I. Association of bystander cardiopulmonary resuscitation and neurological outcome after out-of-hospital cardiac arrest due to drowning in Japan, 2013-2016. Resuscitation 2019; 141:111-120. [PMID: 31202824 DOI: 10.1016/j.resuscitation.2019.06.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 05/24/2019] [Accepted: 06/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Early initiation of cardiopulmonary resuscitation (CPR) performed by bystanders is essential in patients with out-of-hospital cardiac arrest (OHCA) due to primary cardiac cause. However, evidence about the effect of bystander CPR on neurologically favorable survival after OHCA due to drowning is scarce and controversial. METHODS This nationwide population-based observational study using prospectively collected government-led registry data included patients with OHCA due to drowning who were transported to an emergency hospital between 2013 and 2016. The primary outcome was one-month neurologically favorable survival defined as Glasgow-Pittsburgh Cerebral Performance Category score of 1-2. The secondary outcomes were one-month survival and prehospital return of spontaneous circulation (ROSC). RESULTS The full cohort (n = 12,139) comprised 6291 (51.8%) male patients, and the mean age was 73.7 (standard deviation [SD], 18.8). Of these, 5157 (42.5%) received bystander CPR, and 6982 (57.5%) did not. 4345 patients receiving bystander CPR were propensity-matched with 4345 patients not receiving bystander CPR. In the propensity score-matched cohort, bystander CPR was associated with increased chance of one-month neurologically favorable survival (0.4% vs. 0.8%; risk ratio [RR], 2.19; 95%confidence interval [CI], 1.21-3.95; P = 0.0076), one-month survival (1.1% vs. 1.7%; RR, 1.55; 95%CI, 1.09-2.22; P = 0.0150), and prehospital ROSC (2.7% vs. 3.5%; RR, 1.30; 95%CI, 1.03-1.65; P = 0.0296). Similar association was observed across a variety of sensitivity analyses. In subgroup analysis, statistically significant difference was not observed in pediatric OHCA due to drowning, although the sample size was too small (n = 218). CONCLUSIONS Among patients with OHCA due to drowning, bystander CPR was associated with increased chance of neurologically favorable survival.
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Affiliation(s)
- Tatsuma Fukuda
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan.
| | - Naoko Ohashi-Fukuda
- Regional Perinatal Medical Center, Department of Obstetrics and Gynecology, Naha City Hospital, 2-31-1 Furujima, Naha-shi, Okinawa, 902-8511, Japan; Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Kei Hayashida
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ichiro Kukita
- Department of Emergency and Critical Care Medicine, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara-cho, Okinawa, 903-0215, Japan
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Abstract
OBJECTIVES To describe survival and 3-month and 12-month neurobehavioral outcomes in children with preexisting neurobehavioral impairment enrolled in one of two parallel randomized clinical trials of targeted temperature management. DESIGN Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest In-Hospital and Out-of-Hospital trials data. SETTING Forty-one PICUs in the United States, Canada, and United Kingdom. PATIENTS Eighty-four participants (59 in-hospital cardiac arrest and 25 out-of-hospital cardiac arrest), 49 males, 35 females, mean age 4.6 years (SD, 5.36 yr), with precardiac arrest neurobehavioral impairment (Vineland Adaptive Behavior Scales, Second Edition composite score < 70). All required chest compressions for greater than or equal to 2 minutes, were comatose and required mechanical ventilation after return of circulation. INTERVENTIONS Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting precardiac arrest status), and at 3 and 12 months postcardiac arrest, followed by on-site cognitive evaluation. Vineland Adaptive Behavior Scales, Second Edition norms are 100 (mean) ± 15 (SD); higher scores indicate better function. Analyses evaluated survival, changes in Vineland Adaptive Behavior Scales, Second Edition, and cognitive functioning. MEASUREMENTS AND MAIN RESULTS Twenty-eight of 84 (33%) survived to 12 months (in-hospital cardiac arrest, 19/59 (32%); out-of-hospital cardiac arrest, 9/25 [36%]). In-hospital cardiac arrest (but not out-of-hospital cardiac arrest) survival rate was significantly lower compared with the Therapeutic Hypothermia after Pediatric Cardiac Arrest group without precardiac arrest neurobehavioral impairment. Twenty-five survived with decrease in Vineland Adaptive Behavior Scales, Second Edition less than or equal to 15 (in-hospital cardiac arrest, 18/59 (31%); out-of-hospital cardiac arrest, 7/25 [28%]). At 3-months postcardiac arrest, mean Vineland Adaptive Behavior Scales, Second Edition scores declined significantly (-5; SD, 14; p < 0.05). At 12 months, Vineland Adaptive Behavior Scales, Second Edition declined after out-of-hospital cardiac arrest (-10; SD, 12; p < 0.05), but not in-hospital cardiac arrest (0; SD, 15); 43% (12/28) had unchanged or improved scores. CONCLUSIONS This study demonstrates the feasibility, utility, and challenge of including this population in clinical neuroprotection trials. In children with preexisting neurobehavioral impairment, one-third survived to 12 months and their neurobehavioral outcomes varied broadly.
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Abstract
Drowning is a leading cause of death in children. Each year there are thousands of injuries in children, some fatal, associated with aquatic adventure sports. Personal water craft rapidly accelerate children to high velocities, as does being towed behind boats on skis or tubes, whereupon children have no control of their speed or direction. Canoeing and white-water kayaking particularly stress the upper limbs and shoulder dislocations are a primary concern. Surfing and kite-surfing generate more injuries to the head and face than other parts of the body and, in scuba diving, children most frequently injure their ears due to the acute pressure changes experienced. Aquatic injuries cost more in children than in adults and residual functional deficits may last a lifetime. There is a pressing need for research into the prevalence and incidence of aquatic injuries in children, so the effectiveness of preventive interventions can be determined.
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Affiliation(s)
- Peter Buzzacott
- a Injury Monitoring and Prevention , Divers Alert Network , Durham , NC , USA.,b School of Sports Science Exercise and Health , University of Western Australia , Crawley , Australia
| | - Anna Mease
- a Injury Monitoring and Prevention , Divers Alert Network , Durham , NC , USA
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Quan L. Whither the chain of survival? Resuscitation 2017; 115:A8-A9. [DOI: 10.1016/j.resuscitation.2017.03.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 03/29/2017] [Indexed: 10/19/2022]
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