Top Things to Know: P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in Children

Published: September 24, 2020

  1. Cardiac arrest occurs in >20 000 children annually in the United States. Overall survival after in-hospital cardiac arrest increased from 14.3% in 2000 to 39.4% in 2009 most recent survival rates at 48.0% in the United States and from 25.9% to 41% in Spain, while survival after out-of-hospital cardiac arrest remains low at 8.3% to 11.1%.
  2. Children who survive out-of-hospital cardiac arrest can demonstrate decline in neurobehavioral function that is often severe. Many who survive cardiac arrest with a grossly “favorable outcome” have more subtle and sustained neuropsychological impairment.
  3. Studies of pediatric cardiac arrest use inconsistent outcomes, including return of spontaneous circulation and short-term survival, and basic assessments of functional and neurological status.
  4. The core outcome set (COS) identified in this statement includes 5 outcomes: survival, brain function, cognitive function, physical function, and basic daily life skills.
  5. The Pediatric Core Outcome Set After Cardiac Arrest (P-COSCA) initiative provides a standardized platform of outcomes, measures, and time points for assessment that improves the ability to compare results across studies and to analyze results via meta-analyses and systematic reviews.
  6. The P-COSCA improves the utility of future studies by including assessment of prearrest brain functioning and identification of a change in this function after cardiac arrest. This is of particular importance in pediatrics because a high percentage of children who develop cardiac arrest, particularly in the hospital, have preexisting conditions.
  7. Includes a prearrest baseline measure of neurological function, which may reduce bias toward the appearance of poor post–cardiac arrest brain function that may be attributable to prearrest co-morbidities rather than to the cardiac arrest itself, and will enhance understanding of the full scope of outcomes after pediatric cardiac arrest.
  8. Because children may have ongoing brain development occurring independent of the cardiac arrest that affects brain and cognitive function, the P-COSCA intentionally includes assessment of neurological function between 6 and 12 months after cardiac arrest and beyond the first year after cardiac arrest, if possible.
  9. Because it is unclear how age at the time of cardiac arrest impacts longer-term outcomes and lifelong function and development, outcome should be evaluated at key milestones to understand which cardiac arrest survivors will eventually be able to live independently and work.
  10. Future additions of outcomes assessment tools and time points beyond the first year after cardiac arrest, when feasible, will enhance our understanding of pediatric outcomes after cardiac arrest.


Topjian AA, Scholefield BR, Pinto NP, Fink EL, Buysse CMP, Haywood K, Maconochie I, Nadkarni VM, de Caen A, Escalante-Kanashiro R, Ng K-C, Nuthall G, Reis AG, Van de Voorde P, Suskauer SJ, Schexnayder SM, Hazinski MF, Slomine BS. P-COSCA (Pediatric Core Outcome Set for Cardiac Arrest) in children: an advisory statement from the International Liaison Committee on Resuscitation [published online ahead of print September 24, 2020]. Circulation. doi: 10.1161/CIR.0000000000000911.