Abstracts

Rationale: Prognostication in children after cardiac arrest is critical to guiding management decisions, yet accurate prediction of neurological outcome poses a considerable challenge to clinicians. Several promising clinical prognostic indicators exist for adults, including abnormal neurological exam findings, EEG patterns, and myoclonic status epilepticus (MSE) (1). However, few studies exist to substantiate the value of these signs in children. In particular, little is known of the occurrence of post-anoxic MSE in children. In adults, post-anoxic MSE occurs in roughly 30-37% of CPR survivors and portends a poor prognosis (2). This study seeks to further characterize the association between various clinical and EEG findings and neurological outcome, with special attention towards the incidence and prognostic significance of post-anoxic MSE. Elucidation of these associations will guide clinicians and researchers towards the development of multi-modal models for prediction of neurological outcome. Methods: This single-center, retrospective chart review identified 54 consecutive pediatric inpatients experiencing cardiopulmonary arrest from March, 2011 to January, 2015. 22 patients remained after exclusion for initial out-of-hospital arrest or failure to achieve return of spontaneous circulation (ROSC) for > 20 min. Baseline and discharge pediatric cerebral performance category scale (PCPC) was determined by evaluation of prior medical record and neurologic status at discharge. Neurological outcome was dichotomously categorized as favorable (increase in PCPC < 1) or poor (increase in PCPC > 1). 8 patients went on to undergo EEG monitoring within 10 days of the cardiopulmonary event. EEG findings were gathered from a hospital EEG database. Results: 17 patients had a favorable neurological outcome at discharge, while 5 experienced a poor outcome. Figure 1 shows a timeline for the 5 patients who experienced seizures in the 10 day period following cardiac arrest. Patient 4, a non-epileptic with a previous diagnosis of unknown polyneuropathy and mitochondrial dysfunction, experienced MSE on day 1 following respiratory arrest due to tracheitis. This patient had a poor outcome. Patient 3 experienced EEG burst suppression on day 1 and similarly had poor outcome. Low voltage EEG background was unequivocally associated with poor outcome in 3 cases (patients 3, 4, and 5 in figure 1). Among the other clinical variables assessed, absent pupillary response to light (p = 0.0065) and absent motor response to pain (p = 0.0065) were also associated with poor outcome (see table 1). Conclusions: The 4.5% incidence of post-anoxic MSE found in this series of 22 pediatric inpatient survivors of cardiac arrest is considerably lower than the 30-37% incidence previously observed in adults (2). The finding of poor outcome in this patient suggests that post-anoxic MSE may indicate poor prognosis in children, as in adults; however, a multi-center, prospective study with a standardized EEG protocol is warranted to further evaluate the prognostic significance of this previously unreported finding. Funding: N/A