Maayke Hunfeld1, Marlie A C Muusers2, Coriene E Catsman2, Jimena Del Castillo3, Dick Tibboel4, Corinne M P Buysse4. 1. Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, Rotterdam, the Netherlands; Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, Rotterdam, the Netherlands. Electronic address: m.hunfeld@erasmusmc.nl. 2. Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, Rotterdam, the Netherlands. 3. Paediatric Intensive Care Unit, Gregorio Maranon Hospital, Calle del Dr. Esquerdo 46, Madrid, Spain. 4. Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Dr Molewaterplein 40, Rotterdam, the Netherlands.
Abstract
PURPOSE: To describe current practices in European Paediatric Intensive Care Units (PICUs) regarding neuro-prognostication in comatose children after cardiac arrest (CA). METHODS: An anonymous online survey was conducted among members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the European Paediatric Neurology Society (EPNS) throughout January and February 2019. The survey consisted of 49 questions divided into 4 sections: general information, cardiac arrest, neuro-prognostication and follow-up. RESULTS: The survey was sent to 1310 EPNS and 611 ESPNIC members. Of the 108 respondents, 71 (66%) (23 countries, 45 PICUs) completed the "neuro-prognostication" section. Eight PICUs (20%) had a local neuro-prognostication guideline. The 3 methods considered as most useful were neurological examination (92%), magnetic resonance imaging (MRI) (82%) and continuous electroencephalography (cEEG) (45%). In 50% a Pediatric Cerebral Performance Category (PCPC) score ≥ 4 was considered as poor neurological outcome. In 63% timing of determining neurological prognosis was based on the individual patient. Once decided that neurological prognosis was futile, 55% indicated that withdrawing life-sustaining therapy (WLST) was (one of) the options, whereas 44% continued PICU treatment (with or without restrictions). In 28 PICUs (68%) CA-survivors were scheduled for follow-up visits. CONCLUSION: Local guidelines for neuro-prognostication in comatose children after CA are uncommon. Methods to assess neurological outcome were mainly neurological examination, MRI and cEEG. Consequences of poor outcome differed between respondents. Inaccuracies in neuro-prognostication can result in premature WLST, thereby biasing outcome research and creating a self-fulfilling cycle. Further research is needed to develop scientifically based international guidelines for neuro-prognostication in comatose children after CA.
PURPOSE: To describe current practices in European Paediatric Intensive Care Units (PICUs) regarding neuro-prognostication in comatosechildren after cardiac arrest (CA). METHODS: An anonymous online survey was conducted among members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the European Paediatric Neurology Society (EPNS) throughout January and February 2019. The survey consisted of 49 questions divided into 4 sections: general information, cardiac arrest, neuro-prognostication and follow-up. RESULTS: The survey was sent to 1310 EPNS and 611 ESPNIC members. Of the 108 respondents, 71 (66%) (23 countries, 45 PICUs) completed the "neuro-prognostication" section. Eight PICUs (20%) had a local neuro-prognostication guideline. The 3 methods considered as most useful were neurological examination (92%), magnetic resonance imaging (MRI) (82%) and continuous electroencephalography (cEEG) (45%). In 50% a Pediatric Cerebral Performance Category (PCPC) score ≥ 4 was considered as poor neurological outcome. In 63% timing of determining neurological prognosis was based on the individual patient. Once decided that neurological prognosis was futile, 55% indicated that withdrawing life-sustaining therapy (WLST) was (one of) the options, whereas 44% continued PICU treatment (with or without restrictions). In 28 PICUs (68%) CA-survivors were scheduled for follow-up visits. CONCLUSION: Local guidelines for neuro-prognostication in comatosechildren after CA are uncommon. Methods to assess neurological outcome were mainly neurological examination, MRI and cEEG. Consequences of poor outcome differed between respondents. Inaccuracies in neuro-prognostication can result in premature WLST, thereby biasing outcome research and creating a self-fulfilling cycle. Further research is needed to develop scientifically based international guidelines for neuro-prognostication in comatosechildren after CA.
Authors: Talia D Baird; Michael R Miller; Saoirse Cameron; Douglas D Fraser; Janice A Tijssen Journal: Front Pediatr Date: 2021-12-13 Impact factor: 3.418
Authors: Alexis A Topjian; Bingqing Zhang; Rui Xiao; France W Fung; Robert A Berg; Kathryn Graham; Nicholas S Abend Journal: Resuscitation Date: 2021-07-05 Impact factor: 6.251