There is a growing need for neuropsychologists in an inpatient rehab setting and throughout follow-up care for children who are resuscitated after experiencing a cardiac arrest. Today, we talk with Beth Slomine, Ph.D., ABPP-CN, about the risks and benefits associated with therapeutic hypothermia for these children, and her involvement in the THAPCA multi-site trial.
- Defining terminology – cardiac arrest, hypothermia, normothermia, and therapeutic hypothermia after pediatric cardiac arrest (THAPCA)
- Beth discusses how cardiac arrest impacts brain functioning
- She also explains the risks and benefits associated with THAPCA
- Delayed access to medical care is the strongest predictor of poor outcomes in pediatric cardiac arrest
- Beth suggests that children with in-hospital and out-of-hospital cardiac arrest are distinct populations due to outcome differences
- Sampling bias is a significant limitation in THAPCA clinical trials
- Beth discusses important ethical considerations of withholding therapeutic hypothermia
- Preexisting factors associated with survival rate and neurobehavioral outcomes in THAPCA
- Cognitive functioning in pediatric cardiac arrest
- Beth explains the role of a neuropsychologist in an interdisciplinary medical team
- Bonus questions
Dr. Beth Slomine is co-director of the Center for Brain Injury Recovery and director of neuropsychology training and neuropsychological rehabilitation services at Kennedy Krieger Institute. She is an associate professor of Psychiatry & Behavioral Sciences and Physical Medicine & Rehabilitation at Johns Hopkins University School of Medicine. She is a licensed psychologist, board certified clinical neuropsychologist, and board-certified subspecialist in pediatric neuropsychology. Research interests include developing neurobehavioral assessment tools and understanding factors influencing outcome following pediatric neurological injury. Dr. Slomine has authored more than 70 peer-reviewed manuscripts, numerous book chapters, and co-edited a textbook entitled Cognitive Rehabilitation for Pediatric Neurological Conditions.
Holubkov, R., Clark, A. E., Moler, F. W., Slomine, B. S., Christensen, J. R., Silverstein, F. S., et al. (2015). Efficacy outcome selection in the therapeutic hypothermia after pediatric cardiac arrest trials. Pediatr Crit Care Med, 16(1), 1-10.
Moler, F. W., Silverstein, F. S., Meert, K. L., Clark, A. E., Holubkov, R., Browning, B., et al. (2013). Rationale, timeline, study design, and protocol overview of the therapeutic hypothermia after pediatric cardiac arrest trials. Pediatr Crit Care Med, 14(7), e304-315.
Pemberton, V. L., Browning, B., Webster, A., Dean, J. M., & Moler, F. W. (2013). Therapeutic hypothermia after pediatric cardiac arrest trials: the vanguard phase experience and implications for other trials. Pediatr Crit Care Med, 14(1), 19-26.
Schmitt, K. R., Tong, G., & Berger, F. (2014). Mechanisms of hypothermia-induced cell protection in the brain. Mol Cell Pediatr, 1(1), 7.
Slomine, B. S., Silverstein, F. S., Christensen, J. R., Holubkov, R., Page, K., Dean, J. M., et al. (2016). Neurobehavioral Outcomes in Children After Out-of-Hospital Cardiac Arrest. Pediatrics, 137(4).