Maayke Hunfeld

232 Chapter 8 neurological outcome (both including and excluding death) or death at hospital discharge and 2 years post-OHCA. However, solely based on MRI with focal injury (<50% of the brain), it is impossible to predict neurological outcome accurately at hospital discharge or 2 years post-OHCA. In this study, we have attempted to predict neurological outcome without using other OHCA variables. However, due to a small sample size and the use of a crude outcome scale (PCPC), we think that predicting outcome solely based on a normal MRI or MRI with extensive injury, is inappropriate. Besides, MRIs were only performed at the discretion of the treating clinician and not as part of standard care. The children who didn’t receive MRI were more severely affected, creating a selection bias. In 2019, a scientific statement on pediatric post-CA care from the American Heart Association was published (8). The authors also concluded that no single test (neurological exam, EEG, neuro-imaging, SSEP, biomarkers) is sufficiently accurate and reliable for prognostication after pediatric CA. Multiple factors and ancillary tests should be considered when predicting outcome in children who achieve ROC after CA. UNRESOLVED PROBLEMS 1. The precise value of the various available neuromonitoring methods (including neurological exam, routine EEG and continuous EEG, transcranial Doppler, brain MRI and CT, plasma biomarkers, SSEP, and BAEP) to predict outcome of the individual child post- CA is not known. An evidence-based statement on which neuromonitoring method should preferably implemented first is not available. Unresolved problem 1. Potential solution 1a. International collaboration National, but even more importantly, international collaboration is warranted to learn how to implement and interpret available neuromonitoring modalities with regard to neuro-prognostication. Within the Netherlands, this can be achieved through cooperation between all seven PICUs. International collaboration can be accomplished by establishing a pediatric CA consortium with members of the European Society of Paediatric Neonatal Intensive Care (ESPNIC), the European Paediatric Neurology Society (EPNS) with a special interest in this topic and/or the pediatric section of the Intensive Care working group of the European Academy of Neurology (EAN). Besides, outside Europe, collaboration with existing consortia, such as the Pediatric Resuscitation Quality Collaborative (PediRES-Q), is desirable. We are aware that it is difficult to set up randomized controlled trials, due to small patient numbers, different age categories with different neurodevelopmental