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Introducing advanced neuroimaging into pediatric post-arrest neuroprognostication

      In children, the severity of hypoxic-ischemic brain injury (HIBI) after cardiac arrest is the primary determinant of short- and longer-term morbidity and mortality.
      • Topjian A.A.
      • de Caen A.
      • Wainwright M.S.
      • et al.
      Pediatric post-cardiac arrest care: A scientific statement from the American Heart Association.
      • Topjian A.A.
      • Raymond T.T.
      • Atkins D.
      • et al.
      Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
      Prognosticating outcome is challenging and requires a multimodal approach that includes integrating clinical data with information from the neurologic examination, electroencephalography (EEG), and neuroimaging.
      • Hunfeld M.
      • Muusers M.A.C.
      • Catsman C.E.
      • Castillo J.D.
      • Tibboel D.
      • Buysse C.M.P.
      The current practice regarding neuro-prognostication for comatose children after cardiac arrest differs between and within European PICUs: A survey.
      Conventional neuroimaging like computerized tomography (CT) and magnetic resonance imaging (MRI) can quantify the overall extent of structural brain injury. Neurologic outcomes have been associated with burden of HIBI to the whole brain and specific structures.
      • Kirschen M.P.
      • Licht D.J.
      • Faerber J.
      • et al.
      Association of MRI brain injury with outcome after pediatric out-of-hospital cardiac arrest.
      • Manchester L.C.
      • Lee V.
      • Schmithorst V.
      • Kochanek P.M.
      • Panigrahy A.
      • Fink E.L.
      Global and regional derangements of cerebral blood flow and diffusion magnetic resonance imaging after pediatric cardiac arrest.
      • Yacoub M.
      • Birchansky B.
      • Mlynash M.
      • et al.
      The prognostic value of quantitative diffusion-weighted MRI after pediatric cardiopulmonary arrest.
      • Sandroni C.
      • D'Arrigo S.
      • Cacciola S.
      • et al.
      Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
      Advanced neuroimaging modalities like diffusion tensor imaging (DTI) and functional MRI have potential to provide more detailed information about microstructural white matter injury and impairments in functional connectivity between brain regions, which in turn may aid in understanding the pathophysiology of post-arrest HIBI and improve prognostic accuracy.
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