Maayke Hunfeld

17 Introduction 3) Post-CA: In a recent American Heart Association (AHA) statement by Topijan et al., state of the art recommendations are made in order to improve outcome by improving post-ROSC care. The most important are: pursue normoxemia and normocapnia, avoid hypoglycemia, prevent hypotension, maintain normothermia and prevent fever (56). However, scientific evidence for these statements is mostly lacking. As to neuroprognostication, few studies describe the association between outcome and neurological exam and ancillary tests (imaging and electrophysiological assessments) in children after OHCA. In a review by Abend et al. (2008), the absence of pupillary reflexes and motor score as well as a bilateral absent N20 wave on SSEP, electrocerebral silence or burst suppression patterns on EEG and diffusion restriction in the cortex and basal ganglia on magnetic resonance imaging (MRI) are each highly predictive of poor outcome, at least 24 hours after the arrest (57). In the AHA statement, it is recommended to consider multiple modalities (e.g. neurological exam, neuroimaging, EEG, plasma biomarkers) when predicting outcome in children after CA (56). 4) Rehabilitation: Although there is insufficient evidence that after OHCA a specific rehabilitation program is associated with a better outcome, it is plausible that early and intensive rehabilitation may have a positive effect on outcome. This assumption is based on previous studies regarding rehabilitation after pediatric traumatic brain injury and severe brain injury otherwise (58, 59). 5) It is likely that there are factors associated with a good or poor outcome we are not yet aware of or have not been studied in detail yet. As described above, many factors are supposed to be associated with outcome. Unfortunately evidence is often lacking and it is unknown what the predictive value for each factor is for prognosis for each individual patient. Actual research question: Is it possible to develop a prediction outcome model for children post-cardiac arrest based on the above mentioned factors, in particular with the use of neuromonitoring methods such as neurological exam, imaging and electrophysiology post-OHCA? 1