# Quality of Life and Mental Health Problems in Pediatric Cardiac Arrest Survivors

## TL;DR

Most children who survive cardiac arrest have a quality of life similar to healthy peers, but some face emotional, behavioral, and academic challenges that require long-term support.

## Contribution

This is the first German study to examine quality of life and psychological burden in pediatric cardiac arrest survivors with heart disease.

## Key findings

- 72% of pediatric cardiac arrest patients survived to hospital discharge.
- 21% of children showed elevated emotional and hyperactivity-related difficulties, and peer problems.
- One-third of school-aged survivors attend special needs schools, indicating neurodevelopmental and academic impact.

## Abstract

What are the main findings?
Out of 127 pediatric cardiac arrest (CA) patients with heart disease, 72% survived to hospital discharge, and 22 are receiving follow-up care in an outpatient clinic.Overall quality of life was comparable to healthy peers, but children with longer resuscitation time or multiple resuscitations showed lower scores in physical, emotional, social, and school functioning.A total of 21% of children showed elevated emotional and hyperactivity-related difficulties (based on parent reports), and peer problems (based on self-reports), indicating increased psychological stress.One-third of school-aged survivors attend special needs schools, highlighting potential neurodevelopmental and academic impact.

Out of 127 pediatric cardiac arrest (CA) patients with heart disease, 72% survived to hospital discharge, and 22 are receiving follow-up care in an outpatient clinic.

Overall quality of life was comparable to healthy peers, but children with longer resuscitation time or multiple resuscitations showed lower scores in physical, emotional, social, and school functioning.

A total of 21% of children showed elevated emotional and hyperactivity-related difficulties (based on parent reports), and peer problems (based on self-reports), indicating increased psychological stress.

One-third of school-aged survivors attend special needs schools, highlighting potential neurodevelopmental and academic impact.

What is the implication of the main finding?
While survival and average quality of life appear reassuring, a substantial proportion of survivors face subtle but relevant emotional, behavioral, and academic challenges.These findings underscore the urgent need for long-term follow-up programs with routine neurodevelopmental and neuropsychological screening to support at-risk pediatric cardiac arrest survivors.

While survival and average quality of life appear reassuring, a substantial proportion of survivors face subtle but relevant emotional, behavioral, and academic challenges.

These findings underscore the urgent need for long-term follow-up programs with routine neurodevelopmental and neuropsychological screening to support at-risk pediatric cardiac arrest survivors.

Background: Current research is paying more attention to neurological outcomes and quality of life after life-threatening events. Children with heart disease are particularly vulnerable, especially after resuscitation events. While newer data show that adults with heart failure and a left-ventricular assist device suffer from a higher incidence of depression, mental health in pediatric heart disease patients is poorly understood. This is the first study in Germany to examine the quality of life and psychological burden in cardiac arrest survivors with congenital or acquired heart disease. Methods: This monocentric study retrospectively analyzed survival outcomes of pediatric heart disease patients who underwent in-hospital resuscitation between 2008 and 2022. The PedsQL and Strength and difficulties questionnaires were prospectively administered to survivors to assess quality of life and emotional/behavioral problems, while academic achievements were additionally documented. Results: Of 127 patients experiencing cardiac arrest, 91 (71.7%) survived to discharge. Most had complex congenital heart diseases; mean cardiopulmonary resuscitation duration was 14 min. Five patients received extracorporeal cardiopulmonary resuscitation. Of the 22 patients who were receiving follow-up care at the pediatric cardiology outpatient clinic at the time of the study, 14 completed questionnaires were received. Overall quality of life was comparable to healthy controls, though those with prolonged or multiple resuscitations showed lower physical, emotional, social, and school functioning scores. The Strengths and Difficulties Questionnaire revealed no pathological scores but elevated average values for hyperactivity and emotional problems in parent reports, and emotional and peer difficulties in self-reports, indicating increased psychological burden. Conclusions: While survival rates are comparable to international data, gaps exist in structured follow-up and neuropsychological care, especially for high-risk subgroups like ECMO survivors. Routine neuropsychological screening and multidisciplinary outpatient programs are essential to improve long-term follow-up care.