Association Between Deviations From Cerebral Autoregulation-Derived Optimal Blood Pressure and Outcome After Pediatric Cardiac Arrest.

Background And Objectives: Cerebrovascular pressure autoregulation (CAR) maintains adequate cerebral blood flow (CBF) despite changes in cerebral perfusion pressure. CAR is disrupted after cardiac arrest, making the brain vulnerable to inadequate perfusion and oxygen delivery at population-derived guideline-recommended blood pressures. A metric of CAR can be used to determine the mean arterial pressure (MAP) at which CAR is most preserved, termed the optimal MAP (MAP).

Association of EEG Response to Hypertonic Saline and Neurologic Outcomes in Pediatric Acute Brain Injury.

Background: EEG is a critical tool for neuromonitoring and neuroprognostication in children with acute brain injury. Quantitative EEG (qEEG), particularly the alpha-delta ratio (ADR), can detect worsening cerebral ischemia in adults, but it is unknown whether it can identify more subtle and transient changes in cerebral blood flow, such as those induced by hypertonic saline (HTS), in children. We aimed to determine whether we could identify a cohort of patients with an ADR response to HTS and to evaluate the association between an ADR response and neurologic outcomes in critically ill children with acute brain injury.

Machine learning to identify hypoxic-ischemic brain injury on early head CT after pediatric cardiac arrest.

Aims: To train deep learning models to detect hypoxic-ischemic brain injury (HIBI) on early CT scans after pediatric out-of-hospital cardiac arrest (OHCA) and determine if models could identify HIBI that was not visually appreciable to a radiologist.

Methods: Retrospective study of children who had a CT scan within 24 h of OHCA compared to age-matched controls. We designed models to detect HIBI by discriminating CT images from OHCA cases and controls, and predict death and unfavorable outcome (PCPC 4-6 at hospital discharge) among cases.

Hypoxic-ischemic spinal cord injury following resuscitated cardiac arrest: a case series and rapid literature review.

Purpose: Cardiac arrest can cause hypoxic-ischemic injury and result in both spinal cord injury and death determination by neurologic criteria (DNC). The presence and severity of hypoxic-ischemic spinal cord injury (HISCI) impacts neuro-prognostication, rehabilitation, and may confound DNC evaluation in patients by interfering with motor responses and respiratory muscle function in apnea testing. We describe five children with postarrest HISCI detected on magnetic resonance imaging (MRI) and supplement our observations with a literature review.

Themes in the Management of Pediatric Brain Death Contestation: Exploratory Qualitative Work From Multidisciplinary Health Professionals in the United States.

Objectives: To explore health professionals' experiences of contested pediatric brain death/death by neurologic criteria (BD/DNC) cases, including factors contributing to conflict, resource needs and utilization, perceived utility of supports available, and case resolution and aftermath.

Design And Methods: Inductive thematic analysis of semistructured interviews with members of the Society of Critical Care Medicine (SCCM) Contestation of Pediatric Brain Death Task Force.

Setting: Ten institutions across seven U.

Impaired Cerebral Autoregulation in Children.

Managing acute brain injury involves protecting the brain from secondary injury by addressing the mismatch between metabolic demand and cerebral perfusion. Observational studies have associated impaired cerebral autoregulation, a physiological process governing the regulation of cerebral blood flow, with unfavorable neurological outcomes in both pediatric and adult populations. We review the pathophysiology of cerebral autoregulation and discuss methods for assessing and monitoring it in children after acquired brain injury.

States Do Not Delineate the "Accepted Medical Standards" for Brain Death/Death by Neurologic Criteria Determination.

Background: The Uniform Determination of Death Act requires brain death/death by neurologic criteria (BD/DNC) determination to be in accordance with "accepted medical standards." The medical organizations responsible for delineating these guidelines are only specified statutorily in two states. State health organizations (SHOs) are composed of policy experts and medical professionals who are responsible for addressing medical, ethical, and legislative problems related to health.

Practice patterns for acquiring neuroimaging after pediatric in-hospital cardiac arrest.

Aims: To determine which patient and cardiac arrest factors were associated with obtaining neuroimaging after in-hospital cardiac arrest, and among those patients who had neuroimaging, factors associated with which neuroimaging modality was obtained.

Methods: Retrospective cohort study of patients who survived in-hospital cardiac arrest (IHCA) and were enrolled in the ICU-RESUS trial (NCT02837497).

Results: We tabulated ultrasound (US), CT, and MRI frequency within 7 days following IHCA and identified patient and cardiac arrest factors associated with neuroimaging modalities utilized.

Intracranial multimodal monitoring in neurocritical care (Neurocore-iMMM): an open, decentralized consensus.

Background: Intracranial multimodal monitoring (iMMM) is increasingly used in neurocritical care, but a lack of standardization hinders its evidence-based development. Here, we devised core outcome sets (COS) and reporting guidelines to harmonize iMMM practices and research.

Methods: An open, decentralized, three-round Delphi consensus study involved experts between December 2023 and June 2024.

Nuclear Medicine Cerebral Perfusion Studies as an Ancillary Test to Support Evaluation of Brain Death/Death by Neurologic Criteria: Single-Center Experience in Infants, 2005-2022.

Objective: To describe the use of nuclear medicine cerebral perfusion studies as an ancillary test for brain death/death by neurologic criteria (BD/DNC) in infants aged under 1 year.

Design: Retrospective case series.

Setting: Single-center, quaternary, academic children's hospital in the United States.

Elevated serum neurologic biomarker profiles after cardiac arrest in a porcine model.

Introduction: Swine exhibit cerebral cortex mitochondrial dysfunction and neuropathologic injury after hypoxic cardiac arrest treated with hemodynamic-directed CPR (HD-CPR) despite normal Cerebral Performance Category scores. We analyzed the temporal evolution of plasma protein biomarkers of brain injury and inflammatory cytokines, as well as cerebral cortical mitochondrial injury and neuropathology for five days following pediatric asphyxia-associated cardiac arrest treated with HD-CPR.

Methods: One-month-old swine underwent asphyxia associated cardiac arrest, 10-20 min of HD-CPR (goal SBP 90 mmHg, coronary perfusion pressure 20 mmHg), and randomization to post-ROSC survival duration (24, 48, 72, 96, 120 h; n = 3 per group) with standardized post-resuscitation care.

Exploring Ethical Dimensions in Neuropalliative Care.

Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism.

Association of Postarrest Hypotension Burden With Unfavorable Neurologic Outcome After Pediatric Cardiac Arrest.

Objective: Quantify hypotension burden using high-resolution continuous arterial blood pressure (ABP) data and determine its association with outcome after pediatric cardiac arrest.

Design: Retrospective observational study.

Setting: Academic PICU.

Use of neurological criteria to declare death in children.

Accurate determination of death is a necessary responsibility of the medical profession. Brain death, or death by neurological criteria (DNC), can be legally declared after the determination of permanent loss of clinical brain function, including the capacity for consciousness, brainstem reflexes, and the ability to breathe spontaneously. Despite longstanding debates over the exact definition of brain death or DNC and how it is determined, most middle- and high-income countries have compatible medical protocols and legal policies for brain death or DNC.