Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children. (April 2023)

• Record Type: Journal Article
• Authors: Henry, Matthew; Filipp, Stephanie L.; Aydin, Elber Yuksel; Chiriboga, Nicolas; Zelinka, Kailea; Smith, Lorena Espinosa; Gurka, Matthew J.; Irazuzta, Jose; Fonseca, Yudy; Winter, Meredith C.; Pringle, Charlene
• Is Part Of: Resuscitation. Volume 185(2023)
• Publication Date: 2023-04
• Subjects: Brain Death -- Out-of-hospital cardiac arrest -- OHCA -- Outcomes -- Pediatric Critical Care -- Pediatric OHCA -- Post-Arrest Prognostication -- Post-Resuscitation Care -- Prognostication; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2023.109727
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim: 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. Methods: 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. Results: 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). Conclusions: The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.