Maayke Hunfeld

27 Review neuromonitoring Introduction Each year 15.000 children experience an in-hospital cardiac arrest (IHCA) and approximately 6000 an out-of-hospital cardiac arrest (OHCA) in the United States (1-4). The survival rate after cardiac arrest (CA) has increased due to early bystander basic life support, improved availability of automated external defibrillators, increased use of air medical services on site, the use of extracorporeal cardiopulmonary resuscitation (ECPR) and standardized care during the post-resuscitation phase (5-7). However, mortality reduction has led to an increase in morbidity due to hypoxic- ischemic brain injury with an impact on quality of life (8). Predicting outcome in children who have reached return of circulation (ROC) remains challenging, particularly in those who do not regain consciousness within 24 hours (9). Early adequate neuroprognostication is important, especially for this group, to individualize prediction of long-term outcome and assist in decision making concerning withdrawal of life-sustaining therapies or rehabilitation planning. To date, no guidelines exist for prognostication of children post-CA in contrast to adults (6). Extrapolating these adult guidelines to children is inappropriate, since children have age-dependent anatomy and physiology relevant to CNS injury (10). A recent scientific statement from the American Heart Association recommends considering multiple modalities (e.g. neurological examination, neuroimaging, electroencephalopgraphy (EEG), plasma biomarkers ) when predicting outcome in children after CA (11). The aim of this systematic review is to summarize the literature of the last 20 years on neuromonitoring modalities in children after CA and to evaluate their potential prognostic value in predicting neurological outcome at an early stage. Methods Search strategy A search of the literature published between 1998 and March 2019 was performed in Embase.com, MEDLINE Ovid, PsycINFO Ovid, Web of Science Core Collection, Cochrane CENTRAL registry of trials, and Google Scholar using a combination of controlled vocabulary terms and words in title or abstract to define concepts such as pediatric CA, hypoxic-ischemic brain injury, and neuromonitoring (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/PCC/B351) . 2