title: Thermoregulate, autoregulate and ventilate: brain-directed critical care for pediatric cardiac arrest.
abstract: OBJECTIVE
  Cardiac arrest in childhood is associated with a high risk for mortality and poor long-term functional outcome. This review discusses the current evidence for neuroprotective therapies and goals for postarrest care in the context of the pathophysiology of hypoxic-ischemic injury, modalities for neurologic prognostication in these children and potential future monitoring paradigms for maximizing cerebral perfusion in the postarrest period.
  
  
  RESULTS
  The recent publication of the in-hospital and out-of-hospital Therapeutic Hypothermia After Cardiac Arrest trials demonstrated a lack of statistically significant benefit for the use of postarrest therapeutic hypothermia. As a result, targeted normothermic temperature management has become standard of care. Continuous electroencephalographic monitoring during the acute postarrest period provides useful additional data for neurologic prognostication, in addition to its value for detection of seizures. Ongoing research into noninvasive monitoring of cerebrovascular autoregulation has the potential to individualize blood pressure goals in the postarrest period, maximizing cerebral perfusion in these patients.
  
  
  CONCLUSIONS
  Therapeutic strategies after cardiac arrest seek to maximize cerebral perfusion while mitigating the effects of secondary brain injury and loss of autoregulation. Future research into new monitoring strategies and better long-term outcome measures may allow more precise targeting of therapies to these goals.
authors.affiliation: Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Kurz
authors.forename: Craig M
authors.initials: CM
authors.lastname: Smith
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
mesh_terms: D001833:Body Temperature Regulation; D020208:Brain Injury, Chronic / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D003422:Critical Care / Q000379:methods*; D004569:Electroencephalography; D006323:Heart Arrest / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D006706:Homeostasis; D006801:Humans; D007036:Hypothermia, Induced; D020925:Hypoxia-Ischemia, Brain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000628:therapy; D010372:Pediatrics; D011379:Prognosis; D012121:Respiration, Artificial / Q000379:methods*