Introduction: Long-term functional outcomes after in-hospital cardiac arrest (IHCA) in children with cardiac disease remain poorly understood. We aimed to evaluate the evolution of functional status after hospital discharge following IHCA in children with heart disease. Methods: Retrospective cohort study of children with heart disease who had an IHCA in the CICU or inpatient cardiology unit between 2010-2024 at the Children’s Medical Center of Dallas. The cohort was divided into the following groups based on changes in Functional Status Scale (FSS) scores from discharge to 1 and 5 years post-discharge: (1) unchanged or increased scores (indicating stable or worsened function) and (2) decreased scores (indicating improved function). Univariate analyses were performed to assess associations between demographic and clinical variables (age, race, ethnicity, gender, genetic syndrome, single ventricle physiology, illness category, data related to cardiac surgery, extracorporeal cardiopulmonary resuscitation, extracorporeal membrane oxygenation use, CPR duration) and therapies utilized after IHCA and changes in functional status. Results: Of 124 children who survived to hospital discharge, we evaluated 96 children at 1 year and 67 children at 5 years post discharge. The median FSS scores were: 9 8,12 at discharge, 8 7, 10 at 1 year, and 7 6,8 at 5 years post-discharge. At 1 year post discharge, 64.8% of children had improved FSS scores. At 5 years post discharge, 79% of children had improved FSS scores. No demographic or clinical variables analyzed were associated with improved FSS scores from discharge to 1- or 5-years post-discharge. However, compared to children with stable or worsened functional status, those with improved status were less likely to use behavioral therapy 5 years post-discharge (p = 0.005). Conclusions: In this single center retrospective cohort study of children with cardiac disease who developed IHCA, functional outcomes typically improved after hospital discharge. No demographic or clinical variable was associated with functional improvement, however the need for behavioral therapy post-discharge was linked to worse or unchanged functional status. Future investigations should assess if any demographic and clinical variables are associated with improvements in specific FSS domains.
Pratt et al. (Sun,) studied this question.