Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: a systematic review and meta-analysis

Barnaby R Scholefield; Janice Tijssen; Saptharishi Lalgudi Ganesan; Mirjam Kool; Thomaz Bittencourt Couto; Alexis Topjian; Dianne L Atkins; Jason Acworth; Will McDevitt; Suzanne Laughlin; Anne-Marie Guerguerian; International Liaison Committee on Resuscitation (ILCOR) and ILCOR Pediatric Life Support Task Force

doi:10.1016/j.resuscitation.2024.110483

Prediction of good neurological outcome after return of circulation following paediatric cardiac arrest: a systematic review and meta-analysis

Resuscitation. 2024 Dec 30:110483. doi: 10.1016/j.resuscitation.2024.110483. Online ahead of print.

Affiliations

¹ Department of Critical Care Medicine, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Neurosciences and Mental Health Program, Research Institute Toronto, ON, Canada. Electronic address: Barney.Scholefield@sickkids.ca.
² Western University, Department of Paediatrics, London, ON, Canada & Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada.
³ Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, UK.
⁴ Hospital Israelita Albert Einstein AND Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brasil.
⁵ The Children's Hospital of Philadelphia, Department of Anesthesiology and Critical Care Medicine, and and Pediatrics, University of Pennsylvania Perelman School of Medicine, PA, USA.
⁶ Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
⁷ Emergency Department, Queensland Children's Hospital, Brisbane, Australia.
⁸ Department of Neurophysiology, Birmingham Women's and Children's NHS Foundation Trust, and Institute of Cardiovascular Sciences, University of Birmingham, UK.
⁹ Department of Diagnostic and Interventional Radiology, Hospital for Sick Children, ON, Canada, Department of Medical Imaging, University of Toronto, ON, Canada.
¹⁰ Department of Critical Care Medicine, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Neurosciences and Mental Health Program, Research Institute Toronto, ON, Canada.

PMID: 39742939
DOI: 10.1016/j.resuscitation.2024.110483

Abstract

Aim: To evaluate the ability of blood-biomarkers, clinical examination, electrophysiology, or neuroimaging, assessed within 14 days from return of circulation to predict good neurological outcome in children following out- or in-hospital cardiac arrest.

Methods: Medline, EMBASE and Cochrane Trials databases were searched (2010-2023). Sensitivity and false positive rates (FPR) for good neurological outcome (defined as either 'no, mild, moderate disability or minimal change from baseline') in paediatric survivors were calculated for each predictor. Risk of bias was assessed using the QUIPS tool.

Results: Thirty-five studies (2974 children) were included. The presence of any of the following had a FPR <30% for predicting good neurological outcome with moderate (50-75%) or high (>75%) sensitivity: bilateral reactive pupillary light response within 12h; motor component ≥4 on the Glasgow Coma Scale score at 6h; bilateral somatosensory evoked potentials at 24-72h; sleep spindles, and continuous cortical activity on electroencephalography within 24h; or a normal brain MRI at 4-6d. Early (≤12h) normal lactate levels (<2mmol/L) or normal s100b, NSE or MBP levels predicted good neurological outcome with FPR rate <30% and low (<50%) sensitivity. All studies had moderate to high risk of bias with timing of measurement, definition of test, use of multi-modal tests, or outcome assessment heterogeneity.

Conclusions: Clinical examination, electrophysiology, neuroimaging or blood-biomarkers as individual tests can predict good neurological outcome after cardiac arrest in children. However, evidence is often low quality and studies are heterogeneous. Use of a standardised, multimodal, prognostic algorithm should be studied and is likely of added value over single modality testing.

Keywords: Biomarker; Clinical examination; Electroencephalogram; Paediatric cardiac arrest; computed tomography; magnetic resonance imaging; prognosis.

Publication types

Review