Neurological Prognostication in Children After Cardiac Arrest

Abstract

Early after pediatric cardiac arrest, families and care providers struggle with the uncertainty of long-term neurological prognosis. Cardiac arrest characteristics such as location, intra-arrest factors, and postarrest events have been associated with outcome. We paid particular attention to postarrest modalities that have been shown to predict neurological outcome. These modalities include neurological examination, somatosensory evoked potentials, electroencephalography, and neuroimaging. There is no one modality that accurately predicts neurological prognosis. Thus, a multimodal approach should be undertaken by both neurologists and intensivists to present a clear and consistent message to families. Methods used for the prediction of long-term neurological prognosis need to be specific enough to identify indivuals with a poor outcome. We review the evidence evaluating children with coma, each with various etiologies of cardiac arrest, outcome measures, and timing of follow-up.

Keywords: EEG; MRI; Outcome; Pediatric cardiac arrest; Prognostication; SEP.

Figure 1:. Post-arrest EEG Monitoring

(Two-column image): Four EEGs all within 1 day after cardiac arrest displayed in a longitudinal bipolar montage. All EEGs are displayed with the same sensitivity at 7 uV/mm. (A) Continuous background with symmetric sleep spindles; (B) slow-disorganized background; (C) discontinuous/burst-suppression background; (D) severe voltage attenuation. EEG = electroencephalogram.

Figure 2:. Post-arrest Imaging

(Two-column image): (A,B) 16-year-old boy with HCT performed within 24 hours after cardiac arrest from respiratory arrest. HCT displays effacement of the sulci, occipital horns of the ventricles, and basilar cisterns, indicating diffuse cytotoxic edema secondary to hypoxic ischemic injury. (C,D) 3-year-old boy with MRI performed 2 days after cardiac arrest from respiratory arrest. DWI (C) and FLAIR (D) demonstrate diffusion abnormalities and hyperintensities in bilateral caudate and putamen consistent with hypoxic ischemic injury; HCT = head computed tomography; MRI = magnetic resonance imaging; DWI = diffusion weighted imaging; FLAIR = fluid-attenuated inversion recovery.