The period following resuscitation after cardiac arrest is a critical time during which the identification and management of neurological injury may lead to increased survival and improved long-term functional outcomes. Neuromonitoring can guide patient management and aid in prognostication following cardiac arrest. EEG background patterns may be useful in outcome prognostication for some patients within 24 hours of cardiac arrest. Similarly, EEG monitoring is often employed for detection of seizures after pediatric cardiac arrest; seizures are common and are most often subclinical. Hypothermia may impact the interpretation and optimal timing of neuromonitoring data used for prognostication. Experts recommend a multimodal approach to prognostication. In this chapter, we discuss cEEG monitoring, quantitative EEG methods for seizure identification, and EEG background interpretation. We discuss SSEPs and NIRS and their respective roles in neurological management and prognostication. We also address how therapeutic hypothermia (TH) and medication exposure can change the reliability of some of these neuromonitoring tools.

Status epilepticus is a life-threatening and time-sensitive emergency. Continuous EEG monitoring allows the detection of electrographic seizures and electrographic status epilepticus. Increasing evidence guides best practices for which patients to monitor for these conditions and appropriate duration of monitoring. The treatment of SE consists of benzodiazepines, non-benzodiazepines, antiepileptic drugs, and continuous infusions; cEEG monitoring is helpful in assessing the response to treatment. Interpretation of EEG after electrographic seizures requires care, as some patterns on the ictal-interictal continuum may be challenging. This chapter reviews current evidence regarding neuromonitoring and the management of status epilepticus and recurrent seizures.

Extracorporeal membrane oxygenation (ECMO) is a temporary cardiopulmonary support for neonates and children with potentially reversible cardiopulmonary disorders. Patients requiring ECMO support are at risk for brain injury due to pre-ECMO medical conditions, ECMO cannula placement in the carotid artery and internal jugular vessels, and complications arising during ECMO. Acute brain injury may result in acute symptomatic seizures. Clinical and electrographic seizures are common in neonates and children undergoing ECMO. At the same time, the majority of seizures during ECMO are subclinical, and can only be diagnosed through continuous EEG monitoring. Thus, recent consensus statements have recommended increasing use of continuous EEG monitoring (cEEG) during ECMO in neonates and children. This chapter reviews the available data regarding seizure incidence, risk factors, and outcomes in neonates and children requiring ECMO support.