Postcardiac arrest syndrome: focus on the brain.
OBJECTIVE
The field of pediatric cardiac arrest experienced recent advances secondary to multicenter collaborations. This review summarizes developments during the last year and identifies areas for further research.


RESULTS
A large retrospective review demonstrated important differences in cause, severity, and outcome of in-hospital vs. out-of-hospital pediatric cardiac arrest. This distinction is relevant to interpretation of retrospective studies that may not distinguish between these entities, and in planning therapeutic clinical trials. Hypothermia was further evaluated as a treatment strategy after neonatal hypoxia and leaders in the field of neonatology recommend universal use of hypothermia in term neonates at risk. In infants and children after cardiac arrest, there are inadequate data to make a specific recommendation. Two retrospective studies evaluating hypothermia in children after cardiac arrest found that it tended to be administered more frequently to sicker patients. However, similar or worse outcomes of patients treated with hypothermia were observed. Use of extracorporeal membrane oxygenation is another emerging area of research in pediatric cardiac arrest, and surprisingly good outcomes have been seen with this modality in some cases.


CONCLUSIONS
Therapeutic hypothermia and extracorporeal membrane oxygenation continue to be the only treatment modalities over and above conventional care for pediatric cardiac arrest. New approaches to monitoring, treatment, and rehabilitation after cardiac arrest remain to be explored.
Manole
Mioara D
MD
Department of Pediatrics, Children's Hospital of Pittsburgh, Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15260, USA. mioara.manole@chp.edu
Kochanek
Patrick M
PM
Fink
Ericka L
EL
Clark
Robert S B
RS
D001927:Brain Diseases / Q000209:etiology* / Q000628:therapy; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects / Q000379:methods; D002560:Cerebrovascular Circulation; D002648:Child; D002675:Child, Preschool; D015199:Extracorporeal Membrane Oxygenation / Q000009:adverse effects / Q000379:methods; D006323:Heart Arrest / Q000150:complications* / Q000628:therapy; D006801:Humans; D007036:Hypothermia, Induced / Q000009:adverse effects / Q000379:methods; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013577:Syndrome