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

TL;DR

This study found that while many children who survived drowning-related cardiac arrests had good overall outcomes, they often had significant neuropsychological deficits, highlighting the need for long-term follow-up programs.

Contribution

The study provides new insights into long-term neurological outcomes in children after drowning-related cardiac arrests and advocates for standardized follow-up programs.

Findings

A high mortality rate was observed in children admitted after drowning-related cardiac arrests.

Survivors showed significant deficits in neuropsychological assessments despite favorable functional outcomes.

The study emphasizes the need for specialized long-term follow-up programs for these children.

Abstract

•In all children who were admitted after an OHCA due to drowning, a high mortality rate was observed;•Most survivors had a favorable functional outcome (PCPC) at longest available follow up;•However, significant deficits in neuropsychological assessments were found;•Our study emphasizes the importance of establishing a specialized follow-up program.

In all children who were admitted after an OHCA due to drowning, a high mortality rate was observed;

Most survivors had a favorable functional outcome (PCPC) at longest available follow up;

However, significant deficits in neuropsychological assessments were found;

Our study emphasizes the importance of establishing a specialized follow-up program.

Investigate long-term outcome in paediatric submersion-related cardiac arrests (CA).

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.

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).

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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