Maayke Hunfeld

230 Chapter 8 Thesis at a glance The research in this thesis describes various aspects of outcome in children with out- of-hospital cardiac arrest (OHCA). In the first part, neuromonitoring method studies were reviewed regarding the specificity and sensitivity of monitoring modalities to predict outcome in children admitted to the Pediatric Intensive Care Unit (PICU) post- cardiac arrest (CA). Furthermore, the current practice of neuro-prognostication for comatose CA survivors among European pediatric intensivists and neurologists was explored. These evaluations were followed by an analysis of survival and causes of death in children admitted to the PICU in the Erasmus MC-Sophia Children’s hospital after OHCA and return of circulation (ROC). The prognostic value of early magnetic resonance imaging-diffusion weighted imaging (MRI-DWI) in predicting long-term outcome after pediatric OHCA was examined. Next, the association was explored between shockable rhythms and long- term outcome after pediatric OHCA in Rotterdam, over an 18-year period. Lastly, the neuropsychological outcomes of OHCA survivors 3-6 and 24 months after pediatric OHCA were investigated, with its longitudinal course. The results and future perspectives were described in the general discussion part of the thesis. Part 1. Neuromonitoring methods Chapter 2 presents an overview of neuromonitoring methods and their potential roles in neuro-prognostication in post-CA children, in particular those who remain comatose after achieving ROC. Methods included neurological exam, routine electroencephalography (EEG) and continuous EEG (cEEG), transcranial Doppler (TCD), brain MRI and computed tomography (CT), plasma biomarkers, somatosensory evoked potentials (SSEP), and brainstem auditory evoked potentials (BAEP). We concluded that due to a lack of evidence from the currently available literature, these neuromonitoring methods must be interpreted with extreme caution in the context of the patient’s individual clinical neurological status. The appropriate application in time following the event and the precise interpretation of available modalities still need to be determined in relation to the individual patient. Most promising at this moment is cEEG monitoring, which was addressed in 10 out of 26 studies reviewed. The following EEG patterns were found associated with a poor outcome, including death, within 24 hours post-CA: discontinuous, burst-suppression or flat. Furthermore, a non-reactive pattern EEG and the presence of electrographic status epilepticus are associated with a poor outcome and death(1-5). In contrast, a reactive EEG pattern and a continuous