Beyond hope? Prognostication following pediatric cardiac arrest

This thesis, titled Beyond Hope? Prognostication Following Pediatric Cardiac Arrest, explores the complex landscape of survival and neurological outcomes in children after cardiac arrest. Drawing on extensive retrospective and prospective data, it identifies key predictors such as initial shockable rhythm and brain MRI findings, and highlights the importance of early recognition and structured post-arrest care. The work shows that survival rates and favorable outcomes have improved over time, especially with increased AED use and better prehospital response. However, infants remain a vulnerable group with high rates of unresolved etiologies.

The second part of the thesis focuses on diagnostic evaluation and post-arrest care. It reveals significant gaps in genetic testing, autopsy rates, and family history documentation, especially in unresolved cases. A standardized post-SCA diagnostic protocol is proposed to improve etiological clarity and enable cascade screening. Additionally, the thesis evaluates oxygen and carbon dioxide exposure post-arrest, finding no significant association with outcomes, but emphasizing the need for real-time monitoring and adherence to guidelines. Prognostic models incorporating clinical, imaging, and biomarker data show strong predictive value for long-term outcomes.

The final part introduces the Dutch nationwide PROGNOSE registry, designed to standardize prognostication and follow-up across pediatric ICUs. It includes multimodal diagnostics (EEG, MRI, biomarkers) and structured long-term assessments. Ethical and socioeconomic factors such as withdrawal of life-sustaining therapy and disparities in care are critically examined. The thesis concludes with a call for international collaboration, individualized care strategies, and innovation through machine learning and adaptive trials to improve outcomes and equity in pediatric cardiac arrest care.