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

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.

scholarly journals Early myoclonus following anoxic brain injury

2018 ◽  
Vol 8 (3) ◽  
pp. 249-256 ◽  
Author(s):  
Alexandra S. Reynolds ◽  
Benjamin Rohaut ◽  
Manisha G. Holmes ◽  
David Robinson ◽  
William Roth ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Functional Outcomes ◽  
Clinical Characteristics ◽  
Cerebral Performance Category ◽  
Adult Survivors ◽  
Performance Category ◽  
Clinical Criteria ◽  
Cortical Myoclonus ◽  
Electrographic Seizures ◽  
Video Eeg

BackgroundIt is unknown whether postanoxic cortical and subcortical myoclonus are distinct entities with different prognoses.MethodsIn this retrospective cohort study of 604 adult survivors of cardiac arrest over 8.5 years, we identified 111 (18%) patients with myoclonus. Basic demographics and clinical characteristics of myoclonus were collected. EEG reports, and, when available, raw video EEG, were reviewed, and all findings adjudicated by 3 authors blinded to outcomes. Myoclonus was classified as cortical if there was a preceding, time-locked electrographic correlate and otherwise as subcortical. Outcome at discharge was determined using Cerebral Performance Category.ResultsPatients with myoclonus had longer arrests with less favorable characteristics compared to patients without myoclonus. Cortical myoclonus occurred twice as often as subcortical myoclonus (59% vs 23%, respectively). Clinical characteristics during hospitalization did not distinguish the two. Rates of electrographic seizures were higher in patients with cortical myoclonus (43%, vs 8% with subcortical). Survival to discharge was worse for patients with myoclonus compared to those without (26% vs 39%, respectively), but did not differ between subcortical and cortical myoclonus (24% and 26%, respectively). Patients with cortical myoclonus were more likely to be discharged in a comatose state than those with subcortical myoclonus (82% vs 33%, respectively). Among survivors, good functional outcome at discharge was equally possible between those with cortical and subcortical myoclonus (12% and 16%, respectively).ConclusionsCortical and subcortical myoclonus are seen in every sixth patient with cardiac arrest and cannot be distinguished using clinical criteria. Either condition may have good functional outcomes.

scholarly journals Standardized visual EEG features predict outcome in patients with acute consciousness impairment of various etiologies

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Michael Müller ◽  
Andrea O. Rossetti ◽  
Rebekka Zimmermann ◽  
Vincent Alvarez ◽  
Stephan Rüegg ◽  
...  
Keyword(s):  
Clinical Features ◽  
Cerebral Performance Category ◽  
Classification Performance ◽  
Training Data ◽  
Favorable Outcome ◽  
Performance Category ◽  
Overall Performance ◽  
Consciousness Impairment ◽  
Favorable Functional Outcome ◽  
Eeg Features

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.

scholarly journals Insights from patients screened but not randomised in the HYPERION trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
J. B. Lascarrou ◽  
Gregoire Muller ◽  
Jean-Pierre Quenot ◽  
Nicolas Massart ◽  
Mickael Landais ◽  
...  
Keyword(s):  
Functional Outcomes ◽  
Prognostic Significance ◽  
Cerebral Performance Category ◽  
Low Flow ◽  
Haemodynamic Instability ◽  
Inclusion Criteria ◽  
Performance Category ◽  
Shockable Rhythm ◽  
Patient Selection Criteria ◽  
Few Data

Abstract Background Few data are available about outcomes of patients screened for, but not enrolled in, randomised clinical trials. Methods We retrospectively reviewed patients who had non-inclusion criteria for the HYPERION trial comparing 33 °C to 37 °C in patients comatose after cardiac arrest in non-shockable rhythm, due to any cause. A good neurological outcome was defined as a day-90 Cerebral Performance Category score of 1 or 2. Results Of the 1144 patients with non-inclusion criteria, 1130 had day-90 information and, among these, 158 (14%) had good functional outcomes, compared to 7.9% overall in the HYPERION trial (10.2% with and 5.7% without hypothermia). Considerable centre-to-centre variability was found in the proportion of non-included patients who received hypothermia (0% to 83.8%) and who had good day-90 functional outcomes (0% to 31.3%). The proportion of patients with a good day-90 functional outcome was significantly higher with than without hypothermia (18.5% vs. 11.9%, P = 0.003). Conclusion Our finding of better functional outcomes without than with inclusion in the HYPERION trial, despite most non-inclusion criteria being of adverse prognostic significance (e.g., long no-flow and low-flow times and haemodynamic instability), raises important questions about the choice of patient selection criteria and the applicability of trial results to everyday practice. At present, reserving hypothermia for patients without predictors of poor prognosis seems open to criticism.

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

2014 ◽  
Vol 168 (7) ◽  
pp. 671 ◽  
Author(s):  
Murray M. Pollack ◽  
Richard Holubkov ◽  
Tomohiko Funai ◽  
Amy Clark ◽  
Frank Moler ◽  
...  
Keyword(s):  
Functional Status ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Overall Performance

scholarly journals Predictors of Functional Outcome after Intraoperative Cardiac Arrest

2014 ◽  
Vol 121 (3) ◽  
pp. 482-491 ◽  
Author(s):  
Anne-Laure Constant ◽  
Claire Montlahuc ◽  
David Grimaldi ◽  
Nicolas Pichon ◽  
Nicolas Mongardon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Ventricular Fibrillation ◽  
Odds Ratio ◽  
Functional Outcomes ◽  
Cerebral Performance Category ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background: Few outcome data are available about intraoperative cardiac arrest (IOCA). The authors studied 90-day functional outcomes and their determinants in patients admitted to the intensive care unit after IOCA. Methods: Patients admitted to 11 intensive care units in a period of 2000–2013 were studied retrospectively. The main outcome measure was a day-90 Cerebral Performance Category score of 1 or 2. Results: Of the 140 patients (61 women and 79 men; median age, 60 yr [interquartile range, 46 to 70]), 131 patients (93.6%) had general anesthesia, 80 patients (57.1%) had emergent surgery, and 73 patients (52.1%) had IOCA during surgery. First recorded rhythms were asystole in 73 patients (52.1%), pulseless electrical activity in 44 patients (31.4%), and ventricular fibrillation/ventricular tachycardia in 23 patients (16.4%). Median times from collapse to cardiopulmonary resuscitation and return of spontaneous circulation were 0 min (0 to 0) and 10 min (5 to 20), respectively. Postcardiac arrest shock was identified in 114 patients (81.4%). Main causes of IOCA were preoperative complications (n = 46, 32.9%), complications of anesthesia (n = 39, 27.9%), and complications of surgical procedures (n = 36, 25.7%). On day 90, 63 patients (45.3%) were alive with Cerebral Performance Category score 1/2. Independent predictors of day-90 Cerebral Performance Category score 1/2 were day-1 Logistic Organ Dysfunction score (odds ratio, 0.78 per point; 95% CI, 0.71 to 0.87; P = 0.0001), ventricular fibrillation/tachycardia as first recorded rhythm (odds ratio, 4.78; 95% CI, 1.38 to 16.53; P = 0.013), and no epinephrine therapy during postcardiac arrest syndrome (odds ratio, 3.14; 95% CI, 1.29 to 7.65; P = 0.012). Conclusions: By day 90, 45% of IOCA survivors had good functional outcomes. The main outcome predictors were directly related to IOCA occurrence and postcardiac arrest syndrome; they suggest that the intensive care unit management of postcardiac arrest syndrome may be amenable to improvement.

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

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

scholarly journals Threshold of Inotropic Score and Vasoactive–Inotropic Score for Predicting Mortality in Pediatric Septic Shock

2021 ◽  
Author(s):  
Dipu Kallekkattu ◽  
Ramachandran Rameshkumar ◽  
Muthu Chidambaram ◽  
Kandamaran Krishnamurthy ◽  
Tamil Selvan ◽  
...  
Keyword(s):  
Septic Shock ◽  
Inotropic Score ◽  
Vasoactive Inotropic Score
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