Relationship Between the Functional Status Scale and the Pediatric Overall Performance Category and Pediatric Cerebral Performance Category Scales

Abstract Background Early prognostication in patients with acute consciousness impairment is a challenging but essential task. Current prognostic guidelines vary with the underlying etiology. In particular, electroencephalography (EEG) is the most important paraclinical examination tool in patients with hypoxic ischemic encephalopathy (HIE), whereas it is not routinely used for outcome prediction in patients with traumatic brain injury (TBI). Method Data from 364 critically ill patients with acute consciousness impairment (GCS ≤ 11 or FOUR ≤ 12) of various etiologies and without recent signs of seizures from a prospective randomized trial were retrospectively analyzed. Random forest classifiers were trained using 8 visual EEG features—first alone, then in combination with clinical features—to predict survival at 6 months or favorable functional outcome (defined as cerebral performance category 1–2). Results The area under the ROC curve was 0.812 for predicting survival and 0.790 for predicting favorable outcome using EEG features. Adding clinical features did not improve the overall performance of the classifier (for survival: AUC = 0.806, p = 0.926; for favorable outcome: AUC = 0.777, p = 0.844). Survival could be predicted in all etiology groups: the AUC was 0.958 for patients with HIE, 0.955 for patients with TBI and other neurosurgical diagnoses, 0.697 for patients with metabolic, inflammatory or infectious causes for consciousness impairment and 0.695 for patients with stroke. Training the classifier separately on subgroups of patients with a given etiology (and thus using less training data) leads to poorer classification performance. Conclusions While prognostication was best for patients with HIE and TBI, our study demonstrates that similar EEG criteria can be used in patients with various causes of consciousness impairment, and that the size of the training set is more important than homogeneity of ACI etiology.

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Relationship of Pediatric Overall Performance Category and Pediatric Cerebral Performance Category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments

Critical Care Medicine ◽

10.1097/00003246-200007000-00072 ◽

2000 ◽

Vol 28 (7) ◽

pp. 2616-2620 ◽

Cited By ~ 228

Author(s):

Debra H. Fiser ◽

Nicholas Long ◽

Paula K. Roberson ◽

Glenda Hefley ◽

Kristin Zolten ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intensive Care Unit Discharge ◽

Cerebral Performance Category ◽

Pediatric Intensive Care ◽

Unit Discharge ◽

Performance Category ◽

Overall Performance ◽

Relationship Of

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Vasoactive-Inotropic Score and Vasoactive-Ventilation-Renal Score as Outcome Predictors for Children on Extracorporeal Membrane Oxygenation

Frontiers in Pediatrics ◽

10.3389/fped.2021.769932 ◽

2021 ◽

Vol 9 ◽

Author(s):

Ira Shukla ◽

Sheila J. Hanson ◽

Ke Yan ◽

Jian Zhang

Keyword(s):

Functional Outcomes ◽

Cerebral Performance Category ◽

Primary Diagnosis ◽

Research Network ◽

Outcome Predictors ◽

Performance Category ◽

Inotropic Score ◽

Multivariable Analyses ◽

Overall Performance ◽

Vasoactive Inotropic Score

We aimed to determine the association of vasoactive-inotropic score (VIS) and vasoactive-ventilation-renal (VVR) score with in-hospital mortality and functional outcomes at discharge of children who receive ECMO. A sub-analysis of the multicenter, prospectively collected data by the Collaborative Pediatric Critical Care Research Network (CPCCRN) for Bleeding and Thrombosis on ECMO (BATE database) was conducted. Of the 514 patients who received ECMO across eight centers from December 2012 to February 2016, 421 were included in the analysis. Patients > 18 years of age, patients placed on ECMO directly from cardiopulmonary bypass or as an exit procedure, or patients with an invalid or missing VIS score were excluded. Higher VIS (OR = 1.008, 95% CI: 1.002–1.014, p = 0.011) and VVR (OR: 1.006, 95% CI: 1.001–1.012, p = 0.023) were associated with increased mortality. VIS was associated with worse Pediatric Cerebral Performance Category (PCPC) (OR = 1.027, 95% CI: 1.010–1.044, p = 0.002) and Pediatric Overall Performance Category (POPC) score (OR = 1.023, 95% CI: 1.009–1.038, p = 0.002) at discharge. No association was found between VIS or VVR and Functional Status Score (FSS) at discharge. Using multivariable analyses, controlling for ECMO mode, ECMO location, ECMO indication, primary diagnosis, and chronic diagnosis, extremely high VIS and VVR were still associated with increased mortality.

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Impact of the cardiopulmonary resuscitation-related injuries on the prognosis after cardiac arrest

European Heart Journal ◽

10.1093/ehjci/ehaa946.1819 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

C Merino Argos ◽

I Marco Clement ◽

S.O Rosillo Rodriguez ◽

L Martin Polo ◽

E Arbas Redondo ◽

...

Keyword(s):

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Cerebral Performance Category ◽

University Hospital ◽

Temperature Management ◽

Performance Category ◽

Neurological Outcomes ◽

Cardiac Care Unit ◽

Sternal Fractures

Abstract Background Cardiopulmonary resuscitation (CPR) manoeuvres involve vigorous compressions with the proper depth and rate in order to keep sufficient perfusion to organs, especially the brain. Accordingly, high incidences of CPR-related injuries (CPR-RI) have been observed in survivors after cardiac arrest (CA). Purpose To analyse whether CPR-related injuries have an impact on the survival and neurological outcomes of comatose survivors after CA. Methods Observational prospective database of consecutive patients (pts) admitted to the acute cardiac care unit of a tertiary university hospital after in-hospital and out-of-hospital CA (IHCA and OHCA) treated with targeted temperature management (TTM 32–34°) from August 2006 to December 2019. CPR-RI were diagnosed by reviewing medical records and analysing image studies during hospitalization. Results A total of 498 pts were included; mean age was 62.7±14.5 years and 393 (78.9%) were men. We found a total of 145 CPR-RI in 109 (21.9%) pts: 79 rib fractures, 20 sternal fractures, 5 hepatic, 5 gastrointestinal, 3 spleen, 1 kidney, 26 lung and 6 heart injuries. Demographic characteristics and cardiovascular risk factors did not differ between the non-CPR-RI group and CPR-RI group. Also, we did not find differences in CA features (Table 1). Survival at discharge was higher in the CPR-RI group [74 (67.8%) vs 188 (48.3%); p<0.001]. Moreover, Cerebral Performance Category (CPC) 1–2 within a 3-month follow-up was significantly higher in the CPR-RI group [(71 (65.1%) vs 168 (43.2%); p<0.001; Figure 1]. Finally, pts who recieved blood transfusions were proportionally higher in the CPR-RI group [34 (32.1%) vs 65 (16.7%)]; p=0.004). Conclusions In our cohort, the presence of CPR-RI was associated with higher survival at discharge and better neurological outcomes during follow-up. Figure 1 Funding Acknowledgement Type of funding source: None

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Abstract 115: One-Year Outcomes in Individual Domains of the Cerebral Performance Category Extended

Circulation ◽

10.1161/circ.138.suppl_2.115 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Katharyn L Flickinger ◽

Melissa J Repine ◽

Stephany Jaramillo ◽

Allison C Koller ◽

Margo Holm ◽

...

Keyword(s):

Cardiac Arrest ◽

Return To Work ◽

Short Term Memory ◽

Demographic Data ◽

Cerebral Performance Category ◽

Logical Thinking ◽

Short Term ◽

Performance Category ◽

Term Memory

Introduction: Cognitive and physical impairments are common in cardiac arrest survivors. Global measures including the Modified Rankin Scale (mRS), Cerebral Performance Category (CPC) and the 10-domain CPC-Extended (CPC-E) tend to improve over 1 year. The CPC-E is scored from 1-5 with higher scores signifying greater impairment. However, with the CPC-E, individual functional domains (alertness, logical thinking, attention, motor skills, short-term memory, basic and complex activities of daily living (ADL), mood, fatigue, and return to work) may recover at different rates. Hypothesis: We hypothesized that patients would have recovery in all domains of the CPC-E at 1 year after index cardiac arrest. Methods: A prospective cohort study of cardiac arrest survivors was conducted between 2/1/16 and 5/31/17. Chart review was done for baseline demographic data. Outcome measures including mRS, CPC, and CPC-E scores were assessed at discharge, 3 months, 6 months, and 1 year. We defined recovery of a CPC-E domain when >90% of patients had scores of 1-2 in that domain. Results: Of 71 subjects, 35 completed the CPC-E at discharge, 35 at 3 months, 25 at 6 months and 31 at 1 year. The most common reasons for exclusion were patient declined or were lost to follow up. The majority (N=37; 52%) were female, with a mean (SD) age of 58(17) years. Most arrests occurred out of hospital (N= 49; 69%), 27 (38%) had a shockable rhythm and the majority (N=37; 54%) were discharged home. CPC-E domains of alertness (N=35, 100%) logical thinking (N=35; 100%), and attention (N=33; 94%) recovered by hospital discharge. BADLs were recovered by 3 months (N=33; 94%). The majority of patients (N=24;77%) experienced slight-to-no disability or symptoms (mRS 0-2 / CPC 1-2) at 1 year follow up. CPC-E short term memory (67%), motor (87%), mood (87%), fatigue (13%), complex ADL (74%), and return to work (55%) did not recover fully by 1 year. Conclusions: In survivors of cardiac arrest, CPC-E domains of alertness, logical thinking, and attention recover rapidly, while domains of short term memory, motor, mood, fatigue, complex ADL and ability to return to work are chronically impaired 1 year after arrest. Interventions to improve recovery in these domains are needed.

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A Reappraisal of Rhythmic Coma Patterns in Children

Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques ◽

10.1017/s0317167100004546 ◽

2005 ◽

Vol 32 (4) ◽

pp. 518-523 ◽

Cited By ~ 7

Author(s):

Rajesh RamachandranNair ◽

Rohit Sharma ◽

Shelly K. Weiss ◽

Hiroshi Otsubo ◽

Miguel A. Cortez

Keyword(s):

Statistical Significance ◽

Prognostic Significance ◽

Favourable Outcome ◽

Category Scale ◽

Rhythmic Pattern ◽

Performance Category ◽

Exact Test ◽

Significant Difference ◽

Overall Performance ◽

Clinically Significant

ABSTRACT:Objective:This study was designed to determine the prevalence of rhythmic coma patterns in comatose children and to ascertain the prognostic significance of reactive rhythmic coma patterns.Methods:We retrospectively analyzed and classified electroencephalogram (EEGs) in comatose children between two months and 18 years of age during the period 1996 - 2003 according to modified Young's classification. Outcome at one-year was scored according to the Paediatric Cerebral and Overall Performance Category Scale. Outcomes were compared using Fisher's exact test and Mann-Whitney test.Results:Analysis of 63 electroencephalogram (EEG) records in 38 patients showed rhythmic patterns in 19 records (30.2%; 9 alpha, 4 spindle, 4 theta and 2 beta coma patterns, total number of children = 14). Aetiology and outcome of alpha coma patterns and other rhythmic coma patterns were similar. In five children, one type of rhythmic pattern changed to another. Records with reactive rhythmic coma 66.7% (6/9), were associated with favourable outcome. Sixty percent of the records (6/10 records in seven children) with non-reactive pattern were associated with unfavourable outcome. This clinically significant difference did not reach statistical significance (lower Paediatric Cerebral and Overall Performance Category Scale score p= 0.14; favourable outcome p=0.19).Conclusion:Rhythmic coma patterns in comatose children are not uncommon. Aetiology, reactivity and outcome of individual patterns are similar and thus make the rhythmic coma patterns distinct EEG signatures in comatose children. There was a clinically significant better outcome with reactive rhythmic coma patterns.

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Abstract 130: Effect of Cardiopulmonary Bypass Resuscitation on Outcomes After Out-of-Hospital Cardiac Arrest: A Nationwide Observational and Propensity Score--Matched Analysis

Circulation ◽

10.1161/circ.130.suppl_2.130 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Sang Do Shin ◽

Kyoung Jun Song ◽

Eui Jung Lee ◽

Young Sun Ro ◽

Yu Jin Lee

Keyword(s):

Cardiopulmonary Bypass ◽

Propensity Score ◽

Hospital Discharge ◽

Cerebral Performance Category ◽

Outcome Data ◽

Performance Category ◽

Original Dataset ◽

Brain Recovery ◽

Nationwide Observational Study ◽

Hospital Cardiac Arrest

Objective: This study aimed to determine whether cardiopulmonary bypass (CPB) resuscitation comparing with conventional cardiopulmonary resuscitation (C-CPR) is associated with improved OHCA outcomes in Korea. Methods: We used a Korean national OHCA cohort database composed of hospital and ambulance data. We included all EMS-treated OHCA with presumed cardiac etiology for the period Jan. 2009 to Dec. 2012 excluding cases without available hospital outcome data. The primary exposure was CPB resuscitation during CPR at emergency department (ED). The endpoints were survival to admission, hospital discharge with brain recovery (cerebral performance category 1 or 2). We compared outcomes between CPB versus non-CBP group using multivariable logistic regression for calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for individual, Utstein, post-resuscitation factors, and comorbidities. using original and propensity-score matched datasets. Results: Of 93,562 patients with OHCA, we included 55,255 excluding non-treated (n=14,733), non-cardiac (n=23,521), and unknown brain recovery at discharge (n=55). Overall survival to admission and to discharge with good brain recovery was 13.5% and 2.1%, respectively. CPB was performed in 207 (0.4%); 0.1% (2009), 0.2% (2010), 0.4% (2011), 0.7% (2012), respectively. Survival to admission was significantly higher in CPB group (78.3%) than non-CPB (13.3%) in original dataset (Adjusted OR=9.98, 95% CI 7.00-14.24). Discharge with good brain recovery was significantly higher in CPB (9.7%) than non-CPB (2.0%) but adjusted OR (95% CI) was not significant in original dataset; 1.15 (0.62-2.13). From propensity score matched dataset (N=414 from 207 CPB cases and 207 non-CPB cases), survival to admission was significantly higher in CPB group (78.3%) than non-CPB (56.0%) (Adjusted OR=5.37, 95% CI 2.82-10.21). Discharge with good brain recovery was significantly lower in CPB (9.7%) than non-CPB (15.9%) with adjusted OR (95% CI); 0.51 (0.24-1.11). Conclusions: The CPB resuscitation has been increased by year and was associated with higher survival to admission. But it is not associated with hospital discharge with brain recovery in nationwide observational study in Korea.

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Abstract 240: Are the Same Resuscitation Protocols Needed for Highly Aged Victims With Out-of-Hospital Cardiac Arrest as Middle or Younger Aged?

Circulation ◽

10.1161/circ.138.suppl_2.240 ◽

2018 ◽

Vol 138 (Suppl_2) ◽

Author(s):

Hiroyuki Hanada ◽

Yoshio Tahara ◽

Satoshi Yasuda ◽

Teruo Noguchi ◽

Kunihiro Nishimura ◽

...

Keyword(s):

Cardiac Arrest ◽

Total Population ◽

Cerebral Performance Category ◽

Population Based ◽

Aged Patients ◽

Performance Category ◽

Aging Society ◽

Shockable Rhythm ◽

Activity Of Daily Life ◽

Hospital Cardiac Arrest

Backgrounds: The population of elderly people aged 65 years or older in 2014 is 33 million, and the aging rate (proportion of the total population) is 26.0% in Japan. Victims facing to out of hospital cardiac arrest (OHCA) are getting older and older. Emergency medical system (EMS) in Japan must do the same resuscitation protocols once called to the patient with OHCA, even when he or she is very old and activity of daily life is very low. We need to clarify whether same resuscitation protocols are required to very highly aged patients with OHCA or not. Methods and Results: From January 2005 through December 2014, we conducted a prospective, population-based, observational study involving the consecutive patients across Japan who had OHCA (n= 1,299,784). The percentage of patients with OHCA aged more than 80 years old was increasing from 37.1% in 2005 to 47.8% in 2014 by 1% each year. Survival at one month after OHCA with cerebral performance category (CPC) scale 1 or 2 were 4,368 out of total 318,590 OHCA (1.4%) in 80’s, 1043 out of 126,546 (0.8%) in 90’s, and 35 out of 5,544 (0.6%) in aged more than 100 (from 100 to 114). Survival at one month after OHCA with CPC scale 1 or 2 was 11.084 out of 234,366 (4.7%) in 50- 60’s. Patients with witnessed OHCA with shockable rhythm and by-stander CPR survived to CPC 1 or 2 at one month after OHCA were 8.0% in 80’s, 4.1% in 90’s, 0 in aged more than 100, and 22.2% in 50-60’s respectably. Conclusion: Number of survivors with CPC 1 or 2 were very few in patients with OHCA aged more than 80 years old, but still existed. Although the same resuscitation protocols are needed for highly aged victims with OHCA, another system which arrow EMS to stop resuscitation should be established in the highly aging society.

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