Maayke Hunfeld

233 General discussion stages of the central nervous system, and the fact that withdrawal of treatment is unavoidable in a subgroup of patients against the background of differences in ethical and cultural points of view internationally. In order to interpret the precise value of the various neuromonitoring modalities, we need to develop standardized care including the use and interpretation of the results of these modalities and outcome measurements for children post-CA (national and international), in particular for children who remain comatose after CA. This international approach to guarantee standardized care should at least include: 1) the collection of individual patient information; 2) post-CA care such as temperature management, RR, Co2, O2 levels; 3) standardized intervals at which neurological exam should be performed; and 4.) a minimum set of ancillary tests post-CA (preferably cEEG, starting as soon as possible after the arrest, and brain MRI within 1 week post-CA). All standardly collected patient data– medical history, etiology of CA, CPR variables such as duration, witnessed arrest, bystander CPR, clinical exam, neurological exam, post arrest-care, neurological ancillary tests and outcome – should be stored in an electronic database, taking into account the FAIR principles (principles to improve Findability, Accessibility, Interoperability and Reusability) (9). Analysis of the data of a large patient sample could eventually enable us to design evidence-based guidelines for the management of the individual patient. This operation is a tremendous challenge in view of the current lack of financial resources and differences in expertise between countries and even between hospitals in Europe. Self-fulfilling prophecy will remain an issue because clinicians will potentially use the information collected in this setting for decision making in favor of prematurely withdrawing technological support, thus leading to a bias of unfavorable neurological outcome. Potential solution 1b. Quantitative EEG As mentioned earlier, EEG monitoring seems promising in predicting outcome in comatose children post-arrest. Current (international) practice is that experienced physicians, mostly clinical neurophysiologists, interpret an EEG by visual assessment. However, the assessment of specific EEG patterns in children of different ages requires special expertise, as background patterns evolve as children age and their brain matures (10). Furthermore, the interpretation of (c)EEGs is very time consuming, and various degrees of interrater agreement has been reported for the interpretation of EEGs (11-13). A possible solution to do away with the above-mentioned issues is to combine the visual assessment of the EEG with computer-assisted interpretation, also known as quantitative EEG (QEEG). QEEG analyses use computationally derived features that highlight specific components of the EEG with numerical values (14). In adults, QEEG 8