Maayke Hunfeld

37 Review neuromonitoring In summary: given the above mentioned challenges, possibilities and increased awareness and in line with the scientific statement from Topjian et al (11), we would like to recommend the following approach for clinical practice: If a child remains comatose after CA, clinicians should combine individual patient information (medical history, etiology of cardiac arrest, CPR variables like duration, witnessed arrest, bystander CPR etc) with the results of the neurologic examination (serial exams for at least 72 hr) and ancillary tests (at least EEG and MRI) in order to attempt outcome prediction as accurately as possible. In order to take the next step in understanding how best to implement and interpret available neuromonitoring modalities in terms of neuroprognostication, international collaboration is warranted. Although recognizing challenges with this concept due to different financial resources and expertise (between countries and even between hospitals around the world), this approach will enable a larger, more homogenous patient dataset as a starting point. Such standardized data collection with a large patient sample size could finally enable us to design international guidelines that can be implemented for the individual patient. This standardized data set should comprise information on patient characteristics, clinical (neurologic) examination, care and neurological ancillary tests. Outcome measures should include both mortality and long-term follow-up of survivors after CA (> 1 yr and preferably up until adulthood). As stated, long-term follow-up as standard of care (not feasible in research setting) should include both detailed functional and neuropsychological testing as well as health-related quality of life (43). Conclusion A complex condition such as HIE after pediatric CA warrants multimodal neuromonitoring to understand pathophysiology and subsequently predict prognosis. The appropriate application and precise interpretation of available modalities still needs to be determined in relation to the individual patient. The current literature is too heterogeneous, underpowered and lacking long-term, detailed follow-up to draw any conclusions. 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) is the first steps towards more precise, patient-specific neuroprognostication after pediatric CA. 2