• Barnaby R Scholefield, Janice Tijssen, GanesanSaptharishi LalgudiSLWestern University, Department of Paediatrics, London, ON, Canada & Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, London, ON, Canada., Mirjam Kool, Thomaz Bittencourt Couto, Alexis Topjian, Dianne L Atkins, Jason Acworth, Will McDevitt, Suzanne Laughlin, Anne-Marie Guerguerian, and International Liaison Committee on Resuscitation (ILCOR) and ILCOR Pediatric Life Support Task Force.
• 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.
• Resuscitation. 2024 Dec 30: 110483110483.

AimTo 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.MethodsMedline, 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.ResultsThirty-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 12 h; motor component ≥ 4 on the Glasgow Coma Scale score at 6 h; bilateral somatosensory evoked potentials at 24-72 h; sleep spindles, and continuous cortical activity on electroencephalography within 24 h; or a normal brain MRI at 4-6d. Early (≤12 h) 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.ConclusionsClinical 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.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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