Maayke Hunfeld

26 Chapter 2 Abstract Objective Postresuscitation care in children focuses on preventing secondary neurological injury and attempts to provide (precise) prognostication for both caregivers and the medical team. This systematic review provides an overview of neuromonitoring modalities and their potential role in neuroprognostication in post- cardiac arrest children. Data resources Databases EMBASE, Web of Science, Cochrane, Medline Ovid, Google Scholar and PsycINFO Ovid were searched in February 2019. Study Selection Enrollment of children after in- and out-of-hospital cardiac arrest between 1 month and 18 years and presence of a neuromonitoring method obtained within the first 2 weeks post cardiac arrest. Two reviewers independently selected appropriate studies based on the citations. Data extraction Data collected included study characteristics and methodologic quality, populations enrolled, neuromonitoring modalities, outcome and limitations. Evidence tables per neuromonitoring method were constructed using a standardized data extraction form. Each included study was graded according to the Oxford Evidence-Based Medicine scoring system. Data synthesis Of 1195 citations, 27 studies met the inclusion criteria. There were 16 retrospective studies, nine observational prospective studies, one observational exploratory study and one pilot randomized controlled trial. Neuromonitoring methods included neurological examination, routine electroencephalography and continuous electroencephalography, transcranial Doppler, MRI, head CT, plasma biomarkers, somatosensory evoked potentials, and brainstem auditory evoked potential. All evidence was graded 2B-C. Conclusions The appropriate application and precise interpretation of available modalities still needs to be determined in relation to the individual patient. International collaboration in standardized data collection during the (acute) clinical course together with detailed long-term outcome measurements (including functional outcome, neuropsychological assessment and health-related quality of life) are the first steps towards more precise, patient-specific neuroprognostication after pediatric cardiac arrest.