An 18-year, single centre, retrospective study of long-term neurological outcomes in paediatric submersion-related cardiac arrests

Denne Scharink; Maayke Hunfeld; Marijn Albrecht; Karolijn Dulfer; Matthijs de Hoog; Annabel van Gils; Rogier de Jonge; Corinne Buysse

doi:10.1016/j.resplu.2024.100632

An 18-year, single centre, retrospective study of long-term neurological outcomes in paediatric submersion-related cardiac arrests

Resusc Plus. 2024 Apr 13:18:100632. doi: 10.1016/j.resplu.2024.100632. eCollection 2024 Jun.

Authors

Denne Scharink¹, Maayke Hunfeld^{1

2}, Marijn Albrecht¹, Karolijn Dulfer¹, Matthijs de Hoog¹, Annabel van Gils³, Rogier de Jonge¹, Corinne Buysse¹

Affiliations

¹ 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.
² Department of Paediatric Neurology, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
³ 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.

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.

Keywords: Children; Drowning; Long term follow-up; Outcome research; Resuscitation.