Multimodal monitoring including early EEG improves stratification of brain injury severity after pediatric cardiac arrest

Topjian, Alexis; Zhang, Bingqing; Xiao, Rui; Berg, Robert A.; Graham, Kathryn; Abend, Nicholas S.

doi:10.1016/j.resuscitation.2021.06.020

Cited by 16 publications

(22 citation statements)

References 47 publications

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“…The pediatric cardiac arrest population has been a specific focus of EEG background evaluation. In these children, studies have reported a normal background in 3–10%, slow disorganized in 45–49%, burst suppression in 19–25% and attenuated/featureless in 16–33% of patients [ 14 , 16 , 17 ]. Research groups found that the latter two EEG background categories were associated with worse functional outcomes on the PCPC and a higher risk of in-hospital death [ 14 , 16 , 17 , 18 ].…”

Section: Background Featuresmentioning

confidence: 99%

“…In these children, studies have reported a normal background in 3–10%, slow disorganized in 45–49%, burst suppression in 19–25% and attenuated/featureless in 16–33% of patients [ 14 , 16 , 17 ]. Research groups found that the latter two EEG background categories were associated with worse functional outcomes on the PCPC and a higher risk of in-hospital death [ 14 , 16 , 17 , 18 ]. Normal or continuous but slow EEG backgrounds after cardiac arrest have been associated with favorable PCPC outcomes in children [ 18 , 19 ].…”

Section: Background Featuresmentioning

confidence: 99%

“…The presence of sleep spindles and normal sleep patterns in this population has been correlated with better functional outcomes and little to no change in premorbid PCPC scores at discharge [ 19 , 20 ]. Further, recent data reported a lack of sleep spindles was associated with short-term mortality (OR 7.61) and worse functional outcomes based on the PCPC score, GOS-E scale and the Speech Pathology Neurocognitive/Functional Evaluation (SPFNE) (OR 6.46) at discharge [ 14 , 17 ].…”

Section: Background Featuresmentioning

confidence: 99%

“…The most robust pediatric data has emerged from the pediatric cardiac arrest population. Reactivity on EEG in this group has been reported to be between 36% and 46% [ 16 , 17 ]. Lack of reactivity has been consistently associated with worse PCPC scores at discharge compared to their pre-hospital functioning and mortality, whereas patients that demonstrate reactivity on EEG had more favorable outcomes (stable or minimally changed PCPC scores) [ 14 , 16 , 17 , 19 , 21 ].…”

Section: Electrographic Reactivitymentioning

confidence: 99%

“…Reactivity on EEG in this group has been reported to be between 36% and 46% [ 16 , 17 ]. Lack of reactivity has been consistently associated with worse PCPC scores at discharge compared to their pre-hospital functioning and mortality, whereas patients that demonstrate reactivity on EEG had more favorable outcomes (stable or minimally changed PCPC scores) [ 14 , 16 , 17 , 19 , 21 ]. Prajongkit et al evaluated children after cardiac arrest who were undergoing therapeutic hypothermia.…”

Section: Electrographic Reactivitymentioning

confidence: 99%

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The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

2022

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Electroencephalography (EEG) is a neurologic monitoring modality that allows for the identification of seizures and the understanding of cerebral function. Not only can EEG data provide real-time information about a patient’s clinical status, but providers are increasingly using these results to understand short and long-term prognosis in critical illnesses. Adult studies have explored these associations for many years, and now the focus has turned to applying these concepts to the pediatric literature. The aim of this review is to characterize how EEG can be utilized clinically in pediatric intensive care settings and to highlight the current data available to understand EEG features in association with functional outcomes in children after critical illness. In the evaluation of seizures and seizure burden in children, there is abundant data to suggest that the presence of status epilepticus during illness is associated with poorer outcomes and a higher risk of mortality. There is also emerging evidence indicating that poorly organized EEG backgrounds, lack of normal sleep features and lack of electrographic reactivity to clinical exams portend worse outcomes in this population. Prognostication in pediatric critical illness must be informed by the comprehensive evaluation of a patient’s clinical status but the utilization of EEG may help contribute to this assessment in a meaningful way.

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Section: Background Featuresmentioning

confidence: 99%

Section: Background Featuresmentioning

confidence: 99%

Section: Background Featuresmentioning

confidence: 99%

Section: Electrographic Reactivitymentioning

confidence: 99%

Section: Electrographic Reactivitymentioning

confidence: 99%

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The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

2022

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Neuromonitoring after Pediatric Cardiac Arrest: Cerebral Physiology and Injury Stratification

et al. 2023

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Review of Noninvasive Neuromonitoring Modalities in Children II: EEG, qEEG

2023

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Critically ill children with acute neurologic dysfunction are at risk for a variety of complications that can be detected by noninvasive bedside neuromonitoring. Continuous electroencephalography (cEEG) is the most widely available and utilized form of neuromonitoring in the pediatric intensive care unit. In this article, we review the role of cEEG and the emerging role of quantitative EEG (qEEG) in this patient population. cEEG has long been established as the gold standard for detecting seizures in critically ill children and assessing treatment response, and its role in background assessment and neuroprognostication after brain injury is also discussed. We explore the emerging utility of both cEEG and qEEG as biomarkers of degree of cerebral dysfunction after specific injuries and their ability to detect both neurologic deterioration and improvement. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-023-01686-5.

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Multimodal monitoring including early EEG improves stratification of brain injury severity after pediatric cardiac arrest

Cited by 16 publications

References 47 publications

The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review

Neuromonitoring after Pediatric Cardiac Arrest: Cerebral Physiology and Injury Stratification

Review of Noninvasive Neuromonitoring Modalities in Children II: EEG, qEEG

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