Abstract
Purpose: Predicting neurologic prognosis in pediatric patients recovered after cardiac arrest is more difficult than in adults. This study hypothesized that a combination model of early electroencephalography, brain computed tomography (CT), and laboratory findings improve prediction performance of neurologic outcome in pediatric patients after cardiac arrest.Methods: We retrospectively analyzed the medical records of pediatric patients resuscitated after non-traumatic cardiac arrest. Clinical features, electroencephalography, gray matter to white matter attenuation ratio on brain CT, and laboratory findings were analyzed. The primary outcome was neurologic prognosis based on the Pediatric Cerebral Performance Category score.Results: Of 21 patients, seven (33.3%) were classified as a good neurologic outcome group and 14 (66.7%) were classified as a poor neurologic outcome group. The good outcome group was associated with a slow and disorganized electroencephalographic background pattern (P = 0.006), reactivity (P = 0.006), and electrographic seizures (P = 0.03). The frequency of a suppressed electroencephalographic background pattern was significantly higher in the poor outcome group (P = 0.006). The poor outcome group was also associated with a low level of gray matter to white matter attenuation ratio (P = 0.03) and hyperammonemia (P = 0.003). The area under curve of the combined model, consisting of electroencephalographic background, gray matter to white matter attenuation ratio, and ammonia was the highest at 0.959 (0.772–0.999) with a specificity of 100%.Conclusion: Unfavorable electroencephalographic background, low gray matter to white matter attenuation ratio on brain CT, and hyperammonemia are associated with poor neurologic outcome in children after cardiac arrest.
Highlights
The annual incidence rate of out of hospital cardiac arrest worldwide varies from 2.6 to 19.7 children per 100,000 [1, 2] and the Korean annual incidence rate is 4.2 children per 100,000 [3]
With reference to previous studies reported by Metter [14], the Hounsfield unit (HU) values of the caudate nucleus (CN), putamen (PU), genu of the corpus callosum (CC), and posterior limb of the internal capsule (PIC) were obtained at the basal ganglia level of the brain computed tomography (CT)
Of 203 patients, 132 patients who were deceased on arrival, 42 patients who did not undergo an EEG within 72 h, and eight patients who did not have a CT performed within 24 h were excluded
Summary
The annual incidence rate of out of hospital cardiac arrest worldwide varies from 2.6 to 19.7 children per 100,000 [1, 2] and the Korean annual incidence rate is 4.2 children per 100,000 [3]. 47–69% of the patients resuscitated from cardiac arrest remain comatose and do not regain consciousness [4, 5]. Predicting the prognosis in children who suffer cardiac arrest is difficult. An unfavorable electroencephalography (EEG) pattern such as burst-suppression at 24 h after return of spontaneous circulation (ROSC), no light reflex at 48 h, and the absence of somatosensory evoked potential at 72 h are predictive of a poor prognosis [6]. In studies on pediatric patients, neurologic outcome is good if the early EEG background is normal or if only slowing EEG background is present [7]. Structural changes on brain computed tomography (CT) are known to be associated with a poor neurologic prognosis [8]. Hyperammonemia is known as one of signs of poor neurologic outcome [9]
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