Division of Pediatric Neurology, Department of Neurology, Washington University in St. Louis, St. Louis, Missouri.
Division of Critical Care Medicine, Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri.
Pediatr Neurol. 2020 Jul;108:13-22. doi: 10.1016/j.pediatrneurol.2020.03.010. Epub 2020 Mar 15.
Early after pediatric cardiac arrest, families and care providers struggle with the uncertainty of long-term neurological prognosis. Cardiac arrest characteristics such as location, intra-arrest factors, and postarrest events have been associated with outcome. We paid particular attention to postarrest modalities that have been shown to predict neurological outcome. These modalities include neurological examination, somatosensory evoked potentials, electroencephalography, and neuroimaging. There is no one modality that accurately predicts neurological prognosis. Thus, a multimodal approach should be undertaken by both neurologists and intensivists to present a clear and consistent message to families. Methods used for the prediction of long-term neurological prognosis need to be specific enough to identify indivuals with a poor outcome. We review the evidence evaluating children with coma, each with various etiologies of cardiac arrest, outcome measures, and timing of follow-up.
在儿科心搏骤停后早期,家庭和医护人员会对长期神经预后的不确定性感到困惑。心搏骤停的特征,如位置、心搏骤停期间的因素和心搏骤停后的事件,与预后有关。我们特别关注已被证明可预测神经预后的复苏后模式。这些模式包括神经检查、体感诱发电位、脑电图和神经影像学。目前没有一种模式可以准确预测神经预后。因此,神经科医生和重症监护医生应采用多模式方法,向家庭传达清晰一致的信息。用于预测长期神经预后的方法需要足够具体,以识别预后不良的个体。我们回顾了评估昏迷患儿的证据,这些患儿病因各不相同,包括心搏骤停,评估预后的指标和随访时间。