Maayke Hunfeld

11 Introduction at scene (30). Mitani et al. and Fukuda et al. found an increase in survival after implementation of public access defibrillation for children with witnessed OHCA and bystander CPR (31, 32). If survival does increase, what does this mean for long-term consequences among survivors? Namachivayam et al. showed increased morbidity in pediatric CA survivors, suggesting that the price of survival of OHCA may be lifelong neurological sequelae which cause a serious burden for the survivor, families and society (34). Long-term outcome after Out-of-hospital cardiac arrest The occurrence and severity of neurological sequelae in pediatric OHCA survivors, both short-term and long-term, is one of the major concerns of pediatric intensivists and neurologist. Most studies describing survival/outcome after pediatric OHCA are limited to neurological outcome at hospital discharge. Furthermore, there are no clear agreements on the definition of short or long-term. Obviously, outcome at hospital discharge is short-term, but in literature one year post-CA is used both as short and long-term. Pediatric cerebral performance category (PCPC) is often used as an outcome measure in studies describing neurological outcome after pediatric OHCA (35, 36). PCPC is a gross physical outcome scale ranging from 1 to 6 (normal; mild, moderate, or severe disability; comatose; or brain death, table 1). A recent study including 1980 children with OHCA showed that 77% of children who survived to hospital discharge had a relatively favorable outcome expressed in PCPC (PCPC 1 or 2) (28). As part of the Therapeutic Hypothermia after Pediatric Cardiac Arrest (THAPCA) trial in which therapeutic hypothermia was compared with therapeutic normothermia in comatose children after IHCA and OHCA, Silverstein et al. examined PCPC scores of pediatric OHCA survivors at hospital discharge, 3-6 months and 1 year post-arrest (37).Thirty-six percent of survivors had a PCPC score of 1 or 2 at hospital discharge with no significant difference between groups. PCPC score at discharge was significantly correlated with PCPC score at 3-6 and 12 months post-OHCA. There are other methods to determine physical outcome such as general health assessment, neurological exam findings and the assessment of the functional status scale (FSS) (38). In a cohort with 179 children 1 year after IHCA and OHCA, neurological impairments (ranging frommild to profound), detected with neurological exam, were reported in 55% (39). 1