Maayke Hunfeld

121 Cause of death achieving ROC. The Medical Ethical Committee Rotterdam approved the protocol (MEC-2019-0096). CA was defined as unresponsiveness with absent palpable pulse, no signs of life, or healthcare provider perceived need for chest compressions for at least one minute. All data were collected frommedical records and analyzed retrospectively. Data were derived from the electronic health record using an electronic case report form created in an OpenClinica database. A medical student, a pediatric intensivist and a pediatric neurologist were involved in data retrieval. We collected the following: 1) basic patient characteristics (e.g. age, gender, socioeconomic Status (SES), preexisting medical conditions, prearrest pediatric cerebral performance category score (PCPC)), 2) OHCA characteristics (e.g. initial rhythm (shockable/non-shockable), witnessed arrest, cause of arrest, bystander CPR, duration of CPR-event, first lactate and first pH after ROC), 3) post-ROC characteristics (e.g., neurologic examination at multiple time intervals during PICU admission (Glasgow Coma Scale score (GCS)), pupillary light reflexes and brainstem reflexes performed by pediatric neurologist, PICU physician and/or PICU nurse, temperature management, Electroencephalography (EEG) (routine or continuous), brain imaging (MRI, CT and ultrasound), somato sensory evoked potential (SSEP)) and 4) outcome (e.g., survival to hospital discharge (SHD) and PCPC at PICU discharge for survivors). The criteria for targeted temperature management (TTM) were children who remained comatose after ROC. Between 2012-2016 imaging, EEGs and SSEPs were performed when clinically indicated (at the discretion of the treating physicians). In 2017 post-ROSC care guidelines were developed at our PICU recommending continuous EEGs (cEEG) in all children with an impaired consciousness after CA and performing MRI images in all children approximately 5 days after the arrest. In patients following ROC after OHCA who died during PICU or hospital admission (‘non-survivors’), cause of death was categorized as clinical BD, WLST due to poor neurologic prognosis (WLST-Neuro), WLST due to refractory circulatory shock and/ or respiratory failure (WLST-Cardiopulmonary), or recurrent refractory cardiac arrest without ROC (recurrent CA) (15). Patients may have been classified as having more than one cause of WLST. WLST could consist of withdrawal or no escalation of mechanical ventilation, inotropic/vasoactive support or extracorporeal membrane oxygenation (ECMO). In our hospital (in absence of European BD criteria), clinical BD was defined as follows: GCS score of 3 without brainstem reflexes greater than 24 hours after CPR, no sedation (for at least 24 hr) or possible effects of neuromuscular blockade administration at time of neurologic examination by using the train of four (a peripheral nerve stimulator to assess neuromuscular transmission) and a temperature of at least 32 °C. 4