Abstract Body: Introduction: The Pediatric Sequential Organ Failure Assessment (PSOFA) is a severity of illness score that has not been validated in children after IHCA.
Hypothesis: A modified PSOFA (mPSOFA) score, adjusted for post-cardiac arrest care with additional adjustments if ECMO is utilized, measured after pediatric IHCA in a cardiac intensive care unit (CICU) is associated with survival to hospital discharge (SHD).
Methods: This was a retrospective cohort study of IHCA events in children admitted to a single-center pediatric CICU from 9/2016 to 4/2023. Patients were grouped into those who utilized ECMO (including ECPR) and those who did not after ROC. PSOFA was modified for all patients by removing the neurologic score. For days that ECMO was utilized, patients were assigned the maximum cardiovascular and respiratory scores. Total mPSOFA was scored from 0 to 20 with higher scores indicating greater organ dysfunction. Mean mPSOFA scores were calculated daily for 28 days after ROC, or until hospital discharge or death, if they came first. Univariate and multivariable logistic regression models were used to assess the association between mean mPSOFA scores and SHD. A secondary outcome was SHD with favorable neurologic outcome (FNO), defined by Pediatric Cerebral Performance Category (PCPC) discharge score of 1 to 3, or no change from admission.
Results: Of 102 index events, overall SHD was 60.8% (N=62) and SHD w/FNO was 55.9% (N=57). There were 59 patients in the ECMO subgroup. Compared to non-survivors, survivors had lower CPR duration (p=<0.01), ECPR use (p=0.01), and mean mPSOFA scores (3.95±2.32 vs 6.95±4.45, p=0.02). In univariate analysis, increased mean mPSOFA scores were associated with decreased SHD (OR 0.85, 95% CI 0.73-0.98, p=0.03) and SHD w/FNO (OR 0.85, 95% CI 0.74-0.99, p=0.04) in the ECMO subgroup, but only decreased SHD (OR 0.58, 95% CI 0.35-0.96, p=0.03) in patients not requiring ECMO. On multivariable analysis controlling for CPR duration and ECPR use, increased mPSOFA scores were associated with decreased SHD (OR 0.79, 95% CI 0.66-0.95, p=0.01) and SHD w/FNO (OR 0.79, 95% CI 0.66-0.96, p=0.02) for ECMO patients, but were not associated with any measured outcomes for patients not requiring ECMO.
Conclusion: This retrospective study of children admitted to a single-center CICU demonstrates that increased mean mPSOFA scores captured for 28 days after IHCA are associated with decreased SHD for children utilizing ECMO during or after cardiac arrest.