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Research Snapshot Theater: Resuscitation, Pediatric II

Neurologic Risk Factors for Poor Outcomes in the First 24 Hours After Out-of-Hospital Cardiac Arrest

Tuesday, March 24, 2026
11:15 AM - 12:15 PM Central Time
Location: Connections Central - RST 18

  • Maya L. Giaquinta, MD (she/her/hers)

    Wisconsin

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • MS

    Mikal Shankey, DO (she/her/hers)

    Disclosure(s): No relevant financial relationship(s) to disclose.

  • JT

    Janine Taitt, MD

    Resident Physician
    Department of Pediatrics at Medical College of Wisconsin and Children's Wisconsin

    Disclosure information not submitted.

  • RF

    Raquel Farias-Moeller, MD

    Associate Professor
    Department of Pediatrics at Medical College of Wisconsin and Children's Wisconsin

    Disclosure information not submitted.

  • BB

    Binod Balakrishnan, MD

    Associate Professor
    Department of Pediatrics at Medical College of Wisconsin and Children's Wisconsin

    Disclosure information not submitted.

Introduction: Patients with return of circulation after an out of hospital cardiac arrest (OHCA) are at high risk for in-hospital morbidity and mortality from multiorgan dysfunction or anoxic brain injury. Prior studies have not reported early neurologic prognostication factors in the first 24 hours of admission, which may be helpful in deciding candidacy for advanced therapies such as ECMO and in informing families about potential outcomes. We evaluated the association of neurologic parameters in the initial 24 hours after hospitalization with outcomes of children admitted to the pediatric ICU (PICU) after OHCA.


Methods: Single center retrospective study of PICU admissions after OHCA from 2018 to 2024. Data sources were the local Virtual Pediatric Systems registry and the electronic medical records. Categories included demographics, OHCA etiology, CT Head (HCT) findings on admission, neurological pupillary index (NPi) at 0, 6, 12 and 24-hours from admission, EEG findings, admission GCS, and Pediatric Cerebral Performance Category (PCPC) score. Poor outcome was defined as change in PCPC ≥ 2 or death. Factors associated with outcomes are presented using descriptive statistics, and the sensitivity and specificity of their association with outcomes were evaluated. Nominal and ordinal variables were compared using Fisher’s exact test and Mann Whitney U test, respectively.


Results: In this cohort of 218 patients (125 male, 93 female), mean age was 5.4 years, 77% mechanically ventilated (MV) and overall mortality 40% (49% in MV group). The presence of cerebral edema (CE) on HCT or NPi = 0 at 0,6,12 or 24h had high specificity for poor outcomes (88% and 100% respectively). Burst suppression (BS) and flat EEG combined were associated with poor outcomes (94%; sensitivity 0.75 and specificity 0.93). Admission GCS >3, presence of sleep features and reactivity on EEG were associated with survival (89%, 93%, and 93% respectively). The presence of seizures was not associated with outcomes.


Conclusions: Presence of CE on initial HCT, NPi = 0, BS or flat EEG in the first 24h after OHCA are associated with poor outcomes. GCS>3, presence of sleep features and reactivity on EEG were associated with survival.