Additive impact of in-hospital cardiac arrest on the functioning of children with heart disease

Objective. This study examined the impact of a sudden cardiac arrest (CA) on the neurodevelopmental and adaptive functioning of young children with congenital heart disease (CHD). Methodology. Sixteen children with CHD who had sustained an in-hospital CA were compared with a medically similar group of children with CHD who had not incurred a CA. The contribution of CA, disease severity, and family socioeconomic status on the prediction of developmental outcome variables was evaluated. Results. Children in the CA group displayed more impairments in general cognitive, motor, and adaptive behavior functioning as well as greater disease severity as measured by a cumulative medical risk index. With respect to all children in the study, a higher socioeconomic status was related to higher scores on cognitive functioning, lower levels of child maladjustment, and lower levels of stress within the parent-child relationship, Although the occurrence of a CA alone did not contribute to the prediction of outcome measures, a significant interactional effect between CA and cumulative medical risk index was found. Specifically, among children who had incurred a CA, as disease severity increased, decrements in abilities were observed. Few significant correlations between specific CA-related variables (eg, length of CA) and outcome indices were found. Conclusions. Results from this study indicate that the impact of cardiac arrest on neuropsychological functioning may be mediated by the child's overall disease severity. These findings have implications for the identification of CA survivors at greatest risk for developmental difficulties.