Thread by @BarneyUoB

As part of the @ILCOR_org Pediatric life support taskforce we reviewed evidence for accuracy of tests for predicting GOOD neurological outcome following #Cardiacarrest in children
🧵of key DRAFT recommendations.
🔗costr.ilcor.org/document/clini…

#Pedsicu #NeuroPICU

#Prediction of good neurological outcome is a key role for #PedsICU clinicians in #postarrestcare phase of #chainofsurvival.
Improving prognostic #uncertainty may help clinicians choose treatments, counsel families, and answer accurately, "Will my child be OK?“
#NeuroPICU

The #PLS taskforce conducted a #systematicreview of literature reporting prognostic tests used in children after cardiac arrest.
Four types of tests were evaluated:
*Clinical examination
*Blood biomarkers
*Electrophysiology
*Brain Imaging
#PedsICU #NeuroPICU #CPR

We defined ‘Good neurological outcome’ as moderate disability or better using the PCPC score ≥3. But often studies defined it slightly differently, and measured it at different time points.
#PedsICU #NeuroPICU #CPR

The strength of the recommendation reflects the amount and quality of scientific evidence. We used #GRADE to guide us.
Overall the evidence was ‘weak’ with a ‘very-low certainty’, therefore only suggestions (not recommendations) were made.
=Need more research
#PedsICU #NeuroPICU

Importantly, predictive tests were evaluated individually but clinicians did not use the results in isolation when making clinical decisions.
Therefore ⚠️**Don’t use single tests in isolation** ✅
Future research needed on optimal combinations.
#PedsICU #NeuroPICU

#Clinicalexamination tests included checking that pupils react normally to a bright light, or that children moved their muscles in response to commands or being stimulated.
Pupil reflex ✅
Motor scores ?
🔗costr.ilcor.org/document/clini…

#PedsICU #NeuroPICU #CPR

#Bloodbiomarker tests included lactate level and pH (tests of how acidic the blood has become during and after resuscitation) and more detailed blood tests which may detect brain cell damage.
Lactate✅
pH❌
Neurobiomarker ?
🔗costr.ilcor.org/document/blood…
#PedsICU #NeuroPICU #CPR

Electrophysiology tests (eg #EEG, #qEEG, #SSEPs) are used in children post arrest, but require equipment and expertise in interpreting so may not be available everywhere.
We made a number of suggestions
EEG ✅
SSEPs ?
🔗costr.ilcor.org/document/elect…
#PedsICU #NeuroPICU #CPR

#Brainimaging involves the most expensive and complex tests. They may be useful for diagnosis as well as prognosis.
#MRI #CT #TCD (Transcranial doppler) were all evaluated for prognostic accuracy.
MRI ✅
CT ❌
TCD ?
🔗costr.ilcor.org/document/brain…

#PedsICU #NeuroPICU #CPR

Prediction of #poor neurological outcome, which may be linked with decision making on withdrawal of life sustaining therapy will be a future program of work.
These CoSTRs focus on tests predicting #good neurological outcome.
Always keen on your thoughts!

#PedsICU #NeuroPICU

A final massive thank you to the huge international team who worked hard on this programme of work!

@AMGuerguerian @TijssenJanice @Dr_RishiGanesan @mirjam_kool @AlexisTopjian #ThomazBittencourt #LaurieMorrison #DianneAtkins and the @Ilcor_org #PedsTaskForce

#PedsICU #NeuroPICU

TL:DR
1. #Postcardiacarrest good outcome prediction for children
2. @Ilcor_org FULL 'draft' recommendations on costr.ilcor.org
3. Testing Domains:
*Clin Exam ✅
*Biomarkers ✅
*EEG ✅
*MRI ✅
4. More research needed!
5. Comments welcome

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Electrophysiology tests (eg #EEG, #qEEG, #SSEPs) are used in children post arrest, but require equipment and expertise in interpreting so may not be available everywhere.
We made a number of suggestions
EEG ✅
SSEPs ?

Reposted so hopefully readable!