Related Experiment Video
Updated: Dec 14, 2025
Author Spotlight: A Unique Mouse Model of Asphyxia-Induced Cardiac Arrest
Published on: April 14, 2023
The current practice regarding neuro-prognostication for comatose children after cardiac arrest differs between and
Maayke Hunfeld1, Marlie A C Muusers2, Coriene E Catsman2
1Department 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.
Insights
Neuro-prognostication guidelines for comatose children after cardiac arrest (CA) are rare in European PICUs. Current practices vary, highlighting the need for standardized, evidence-based international guidelines to ensure accurate patient assessment and care.
Area of Science:
- Pediatric Intensive Care Medicine
- Pediatric Neurology
- Clinical Neurophysiology
Background:
- Neuro-prognostication in comatose children following cardiac arrest (CA) is critical for guiding clinical decisions.
- Current practices in European Paediatric Intensive Care Units (PICUs) for neuro-prognostication after CA are not well-defined.
- Lack of standardized guidelines may lead to inconsistencies in patient management and outcome assessment.
Purpose of the Study:
- To describe current neuro-prognostication practices in European PICUs for comatose children after CA.
- To identify the methods and timing used for neurological assessment and prognosis determination.
- To understand the approaches to patient management once a poor neurological outcome is suspected or determined.
Main Methods:
- An anonymous online survey was distributed to members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the European Paediatric Neurology Society (EPNS).
- The survey included 49 questions covering general information, CA, neuro-prognostication, and follow-up.
- Data were collected from respondents across 23 countries, representing 45 PICUs.
Main Results:
- Only 20% of participating PICUs had a local neuro-prognostication guideline.
- Neurological examination (92%), MRI (82%), and continuous EEG (cEEG) (45%) were the most utilized methods for assessing neurological outcome.
- Decisions regarding withdrawing life-sustaining therapy (WLST) varied, with 55% considering it an option for futile prognoses, while 44% continued treatment.
Conclusions:
- There is a significant lack of local guidelines for neuro-prognostication in pediatric CA survivors across Europe.
- Variability in assessment methods and outcome interpretation necessitates the development of international, evidence-based guidelines.
- Inaccurate prognostication can lead to premature WLST, potentially impacting research and patient outcomes, underscoring the need for standardized protocols.
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.
Related Concept Videos
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:21Cardiopulmonary Resuscitation I: Adult