Maayke Hunfeld

87 Survey neuroprognostication Once decided that prognosis was futile the consequences differed between European regions. Although the number of respondents was limited, some patterns were identifiable. The majority of respondents fromWestern and Northern Europe indicated WLST as (one of) the consequence(s), as opposed to Eastern and Southern Europe. This is in line with a previous study showing that physicians from North European countries more often decide to WLST compared to Southern part of Europe (40). This is probably the result of personal beliefs and experiences, cultural and religious aspects and local policies. It would be interesting to study the long-term outcome of paediatric comatose CA survivors in countries where WLST is uncommon. At the other end, inaccuracies in neuro-prognostication can result in premature WLST, thereby biasing outcome research and creating a self-fulfilling cycle. Our study has limitations. To the best of our abilities, this survey was carefully designed and instrumentalised in order to address all aspects of the research question and hypothesis. However, we cannot guarantee that our instrument was fully in line with all quality conditions. This survey may not be representative for all PICUs in Europe, because representatives of only 23 European countries participated and the number of responders per nation varied widely (from 1 respondent to 26 responders per country). Seventy-one of 108 respondents completed the neuro-prognostication section and 69 the follow- up section. It is conceivable that responders (in particular paediatric neurologists) did not finish the survey due to the inability to answer the first en second section of the survey (general information and cardiac arrest). Also, questions regarding neuro-prognostication and decisions around WLST can be delicate topics making it complicated for responders to answer these questions. Self-reporting bias, portraying daily practices differently from reality, may have arisen since we used a survey to conduct this study. We asked as many as possible clinicians to respond per PICU in order to gain a clear overview of the local PICU policy. However, this resulted in an overrepresentation of respondents from our own center. Conclusion The current practice regarding neuro-prognostication for comatose children after CA differs between and within European PICUs. The 3 methods considered as most useful are neurological examination, MRI brain and EEG. National or local guidelines are uncommon, presumably resulting in suboptimal neuro-prognostication. Further profound research is required to eventually develop an international guideline for 3