Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children

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...

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Published in:Resuscitation 2023-04, Vol.185, p.109727-109727, Article 109727
Main 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
Format: Article
Language:English
Subjects:
Adult
Brain Death
Brain Death - diagnosis
Cardiopulmonary Resuscitation - methods
Child
Humans
Infant
OHCA
Out-of-Hospital Cardiac Arrest
Outcomes
Pediatric Critical Care
Pediatric OHCA
Post-Arrest Prognostication
Post-Resuscitation Care
Prognosis
Prognostication
Retrospective Studies
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container_start_page 109727
container_title Resuscitation
container_volume 185
creator 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
description 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. 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 
doi_str_mv 10.1016/j.resuscitation.2023.109727
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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. 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 &lt; 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. 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). The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.</description><identifier>ISSN: 0300-9572</identifier><identifier>EISSN: 1873-1570</identifier><identifier>DOI: 10.1016/j.resuscitation.2023.109727</identifier><identifier>PMID: 36764571</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Adult ; Brain Death ; Brain Death - diagnosis ; Cardiopulmonary Resuscitation - methods ; Child ; Humans ; Infant ; OHCA ; Out-of-Hospital Cardiac Arrest ; Outcomes ; Pediatric Critical Care ; Pediatric OHCA ; Post-Arrest Prognostication ; Post-Resuscitation Care ; Prognosis ; Prognostication ; Retrospective Studies</subject><ispartof>Resuscitation, 2023-04, Vol.185, p.109727-109727, Article 109727</ispartof><rights>2023 Elsevier B.V.</rights><rights>Copyright © 2023 Elsevier B.V. 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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). The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.</description><subject>Adult</subject><subject>Brain Death</subject><subject>Brain Death - diagnosis</subject><subject>Cardiopulmonary Resuscitation - methods</subject><subject>Child</subject><subject>Humans</subject><subject>Infant</subject><subject>OHCA</subject><subject>Out-of-Hospital Cardiac Arrest</subject><subject>Outcomes</subject><subject>Pediatric Critical Care</subject><subject>Pediatric OHCA</subject><subject>Post-Arrest Prognostication</subject><subject>Post-Resuscitation Care</subject><subject>Prognosis</subject><subject>Prognostication</subject><subject>Retrospective Studies</subject><issn>0300-9572</issn><issn>1873-1570</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><recordid>eNqNUU1vEzEUtBCIhsJfQJa4cNngr11nxQGhqnxIRb2Us_XWH4kjxw62NwiJH4_TlKq99WTpvZl5Mx6E3lGypIQOH7bLbMtctK9QfYpLRhhvm1Ey-Qwt6EryjvaSPEcLwgnpxl6yM_SqlC0hhPejfInO-CAH0Uu6QH9_zKF6bWPNXuMDBG9uVXFyGPA-p3VMpQFwTSlgl3KbWeN19XGNpww-YmOhbtoqhPT7OE1z7ZLrNqnsm8WANWTjQWPIzXfFjaE3Pphs42v0wkEo9s3de45-frm8ufjWXV1__X7x-arTgova8dWgJzO5kYPQuufWGTsJ6KUULagdhRF8ZFTDijtNLRDBGJlWkg5A-MgdP0efTrr7edpZc5sWgtpnv4P8RyXw6vEm-o1ap4OihAz9KMam8P5OIadfc4uhdr5oGwJEm-aimJT9wAbBZYN-PEF1TqVk6-7vUKKOBaqtelSgOhaoTgU29tuHVu-5_xtrgMsTwLYPO3ibVROyUbdSstVVmeSfdOgf8Lm5HQ</recordid><startdate>20230401</startdate><enddate>20230401</enddate><creator>Henry, Matthew</creator><creator>Filipp, Stephanie L.</creator><creator>Aydin, Elber Yuksel</creator><creator>Chiriboga, Nicolas</creator><creator>Zelinka, Kailea</creator><creator>Smith, Lorena Espinosa</creator><creator>Gurka, Matthew J.</creator><creator>Irazuzta, Jose</creator><creator>Fonseca, Yudy</creator><creator>Winter, Meredith C.</creator><creator>Pringle, Charlene</creator><general>Elsevier B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-9010-0165</orcidid></search><sort><creationdate>20230401</creationdate><title>Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children</title><author>Henry, Matthew ; 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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. 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 &lt; 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. 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). The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.</abstract><cop>Ireland</cop><pub>Elsevier B.V</pub><pmid>36764571</pmid><doi>10.1016/j.resuscitation.2023.109727</doi><tpages>1</tpages><orcidid>https://orcid.org/0000-0002-9010-0165</orcidid><oa>free_for_read</oa></addata></record>
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ispartof Resuscitation, 2023-04, Vol.185, p.109727-109727, Article 109727
issn 0300-9572
1873-1570
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10065949
source ScienceDirect Freedom Collection 2022-2024
subjects Adult
Brain Death
Brain Death - diagnosis
Cardiopulmonary Resuscitation - methods
Child
Humans
Infant
OHCA
Out-of-Hospital Cardiac Arrest
Outcomes
Pediatric Critical Care
Pediatric OHCA
Post-Arrest Prognostication
Post-Resuscitation Care
Prognosis
Prognostication
Retrospective Studies
title Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children
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