Maayke Hunfeld

31 Review neuromonitoring In two retrospective studies of children after IHCA and OHCA (n=353 and 138), bilateral equal responsive pupils at 12 hours post-ROC were associated with survival (p<0.01) (17, 18). However, these studies have limitations. First, clinicians were unblinded to neurological examination findings, which may have influenced treatment decisions (13-16). Furthermore, most studies included small patient numbers with crude outcome scales (13-16). Meert et al and Moler et al both included a large cohort (n=353 and 138 respectively). However they only assessed survival up to hospital discharge. Long-term outcome was not investigated (17, 18). In some studies patients received sedatives or analgesics at time of neurological examination which could have influenced neurologic findings (14, 16). Electroencephalography Ten studies explored the prognostic value of routine and cEEG after pediatric CA; four were prospective observational and six were retrospective (Supplemental Table 3, Supplemental Digital Content 2, http://links.lww.com/PCC/B352) . A summary of six studies including only patients after cardiac arrest and more than 20 patients is given below. The other four studies can be found in Supplemental Table 3 (Supplemental Digital Content 2, http://links.lww.com/PCC/B352) (13, 19-21). Topjian et al evaluated short-term outcome in 128 children after CA treated with controlled normothermia by early cEEG background features (within 24 hr after CA) (22). Worse background categories (discontinuous, discontinuous-burst suppression, attenuated-flat) and absence of EEG reactivity were associated with mortality and poor outcome at hospital discharge. The odds of death increased with each progressively worse background pattern. Status epilepticus was also associated with poor neurologic outcome, not with mortality. Ostendorf et al also showed an association between burst suppression or flat cEEG and poor outcome and a continuous EEG within 12 hours post ROSC with good outcome (n=73) (23). In a retrospective cohort (n=34), routine EEG was employed within 7 days after CA. Ninety percent of children with a discontinuous or isoelectric EEG had a poor outcome at hospital discharge whereas 91% of children with a continuous EEG had a good outcome at hospital discharge (24). Kessler et al (n=35) demonstrated that an unreactive or discontinuous EEG, burst suppression or flat EEG during hypothermia or rewarming was associated with poor outcome (25). Another retrospective study (n=34), demonstrated that the presence of sleep spindles within 24 hours post-ROSC was associated with a good outcome (p=0.001) (26). 2