Maayke Hunfeld

128 Chapter 4 Variable Survivors n = 51 number included patients Post-ROC Targeted temperature management ECMO (ECPR or post-ROC) Seizures (clinical) EEG Seizures * MRI brain Days after CPR event Ischemia Edema CT brain Days after CPR event Ischemia or edema Ultrasound brain Ischemia Edema Abnormal SSEP ** 36 (71) 8 (16) 4 (6.1) 25 (49) 1 (5) 34 (67) 4 (3-6) 12 (35) 5 (15) 20 (39) 0.00 (0-0) 2 (5) 7 (14) 1 (15) 0 (0) 0 (0) (n=22) (n=34) (n=34) (n=34) (n=20) (n=20) (n=7) (n=7) (n=1) Table 2. Survivors vs. Non-survivors and WLST-neuro vs BD: post-ROC characteristics Data are presented as n (%) or median (IQR: 25 th -75 th percentile) * Seizures on rEEG and/or cEEG (regardless of time). ** Abnormal SSEP: bilateral absent N20 wave. OCR= oculocephalic reflex, CR= corneal reflex, ROC= return of circulation, SSEP = somatosensory evoked potential The only significant difference between these two groups post-ROC was a higher number of ECMO procedures in the WLST-Neuro group (p=0.006). There were no differences between the two groups regarding neurologic examination, temperature management or results of ancillary tests (i.e., EEG, brain imaging, SSEP). Cause of Death and Timing of WLST Decision-Making Supplemental table 1 (Supplemental Digital Content 2, http://links.lww.com/ PCC/B539) gives an overview of timing and decision-making of WLST in the WLST- Neuro group (n=30) and WLST-Neuro in combination with WLST-Cardiopulmonary or recurrent CA (n=12). Timing of WLST decision making varied from 0 to 18 days after CPR event (median, 0 d; IQR, 0-3). In 28 patients (67%) the decision to WLST was made within 72 hours after CPR event and in 22 (52%), within 24 hours after the CPR event. The decision-making in these 22 patients was always based on neurologic examination: Absence of brainstem reflexes in all patients but 1 and in all patients a GCS motor response of 1. In 17 of these 22 patients this neurologic examination was combined with at least one additional investigation (EEG or brain imaging). In four children (18%) the prearrest