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Post-ROSC Predictive Factors

Question Type:
Prognostic
Full Question:
Among infants and children with return of circulation (P), does does the presence of any specific factors (I), compared with compared with the absence of those factors (C), change survival to 180 days with good neurological outcome, survival to 60 days with good neurological outcome, Survival only at discharge, 30 days, 60 days, 180 days AND/OR 1 year, survival to 30 days with good neurological outcome, survival to hospital discharge with good neurological outcome (O)?
Consensus on Science:
For the critical outcome of survival to 180 days with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias) from 1 pediatric observational prospective cohort study of IHCA and OHCA,(Fink 2014, 664-674) enrolling 43 children showing that reactive pupils at 24 hours after ROSC is associated with improved outcomes (RR, 5.94; 95% CI, 1.5–22.8). For the important outcome of survival to hospital discharge, we identified very-low-quality evidence for prognostic significance (downgraded for imprecision and risk of bias, but with a moderate-dose response) from 4 pediatric observational studies of IHCA and OHCA,(Nishisaki 2007, 10-17; Meert 2009, 544-553; Moler 2011, 141-149; Abend 2012, 32-38) enrolling a total of 513 children showing that pupils reactive to light 12 to 24 hours after ROSC is associated with improved outcomes (RR, 2.3; 95% CI, 1.8–2.9). For the important outcome of survival to hospital discharge with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for risk of bias and imprecision, but with a moderate effect size) from 2 pediatric observational studies of IHCA and OHCA,(Nishisaki 2007, 10-17; Abend 2012, 32-38) enrolling a total of 69 children showing that pupils reactive to light before hypothermia or 24 hours after ROSC is associated with improved outcomes (OR, 3.0; 95% CI, 1.4–6.5). For the important outcomes of survival to hospital discharge and hospital discharge with good neurologic outcome, we identified very-low-quality evidence for prognostic significance (downgraded for risk of bias and imprecision) from 2 pediatric observational studies of IHCA and OHCA,(Topjian 2009, 479-490; Fink 2014, 664-674) enrolling a total of 78 children showing that lower neuron-specific enolase (NSE) or S100B serum levels at 24, 48, and 72 hours are associated with an increased likelihood of improved outcomes (P
Treatment Recommendation:
We suggest that practitioners use multiple variables when attempting to predict outcomes for infants and children after cardiac arrest (weak recommendation, very-low-quality evidence). Values, Preferences, and Task Force Insights We place greater value on preserving opportunities for recovery than on limiting therapy based on as-yet-unvalidated prognostic tools.
CoSTR Attachments:
GRADE_pupillaryresponsepostROSC REVISED 3 FINAL.docx .docx    
Lactate V4 FINAL.docx .docx    
Neurologic Biomarkers V6 FINAL.docx .docx    
Summary of Bias Assessments Peds 813-2 FINAL.xlsx    

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