Electroencephalographic and clinical predictors of favorable neurologic outcomes in pediatric cardiac arrest survivors

This study aimed to identify neurologic prognostic factors after cardiac arrest in pediatric patients, focusing on clinical features and electroencephalography (EEG) findings. This is a retrospective single-center study. We analyzed resuscitated pediatric patients who admitted pediatric intensive care unit at a tertiary academic referral hospital in South Korea. Patients aged 1 month to 18 years with in-hospital cardiac arrest between January 2010 and October 2022 who received EEG within 7 days were included. The primary outcome was a favorable neurologic outcome, defined as a Pediatric Cerebral Performance Category score of 1-2, assessed at 6 months post-cardiac arrest. Sixty-two pediatric patients were included, with 16 (25.8%) achieving favorable outcomes. Multivariate logistic regression analyses identified initial shockable rhythm (p = 0.032), normal background voltage (p = 0.026), and continuous or nearly continuous background activity (p = 0.017) on standardized EEG as significant predictors of favorable neurologic outcomes at 6 months. The combination of an initial shockable rhythm with normal voltage or continuous EEG background enhanced prognostic accuracy (specificity = 100%). This study suggests that specific EEG background patterns-alpha frequency, normal voltage, and continuous or nearly continuous activity-within 1 week post-return of spontaneous circulation serve as indicators of favorable 6-month neurologic outcomes.