Clinical and Electroencephalographic Correlates in Pediatric Cardiac Arrest: Experience at a Tertiary Care Center

Area of Science:

• Pediatric Critical Care Medicine
• Neurology
• Cardiology

Background:

• Pediatric cardiac arrest leads to significant mortality and neurologic disability.
• Limited research exists on prognostic factors specifically for pediatric populations.
• Early identification of prognostic indicators is vital for guiding treatment and improving outcomes.

Purpose of the Study:

• To identify clinical, laboratory, and electroencephalographic (EEG) factors that predict neurologic outcomes in children after cardiopulmonary arrest.
• To characterize findings that may inform prognosis in pediatric cardiac arrest survivors.

Main Methods:

• Retrospective chart review of 41 pediatric patients who experienced cardiac arrest between March 2011 and January 2015.
• Analysis of pre-arrest clinical characteristics, resuscitation details, and post-arrest hospital course variables.
• Neurologic outcome assessed using the Pediatric Cerebral Performance Category scale.

Main Results:

• Predictors of poor neurologic outcome included: longer duration of cardiopulmonary resuscitation, out-of-hospital arrest, abnormal arterial pH and lactate levels, lack of pupil reactivity, absent motor response, and absent brainstem reflexes.
• EEG background suppression was significantly associated with poor neurologic outcomes (p=0.005).
• Seizures occurred in 9 patients, with 2 experiencing post-anoxic myoclonic status epilepticus, both resulting in poor outcomes.

Conclusions:

• Several clinical and laboratory variables, along with EEG findings, are significant predictors of poor neurologic outcome in pediatric cardiac arrest.
• These factors can aid clinicians in assessing prognosis and potentially guiding therapeutic interventions.
• Further research into EEG patterns and seizure activity post-arrest may offer additional prognostic insights.