Maayke Hunfeld

13 Introduction Slomine et al. assessed neurobehavioral outcome by using the Vineland Adaptive Behavior Scale-second edition (VABS-II) in 85 children one year after OHCA (cohort of THAPCA trial) (42). They all had been temporarily unresponsive and required mechanical ventilation after return of spontaneous circulation (ROSC). All children had a broadly normal baseline functioning (based on VABS-II). Forty nine percent had a VABS-II score ≥ 70 (mean= 100, SD= 15) 12 months after OHCA. Significant declines were found in all domains of caregiver-reported neurobehavioral functioning, including communication, daily living, socialization, and motor skills. Declines were greatest in older children. On objective cognitive measures (<6 years Mullen Scales of Early Learning, ≥ 6 years Wechsler Abbreviated Scale of Intelligence), most children displayed significant deficits (42). In a larger (partly overlapping cohort with the previous study) cohort of Slomine et al. neuropsychological assessments were done one year after pediatric IHCA and OHCA in initially unresponsive children requiring mechanical ventilation after ROSC (n=160) (43). In children younger than 6 years (n=119), scores were significantly lower on Mullen Scales of Early Learning (describing visual perception, fine motor, receptive and expressive language) compared with normative reference group. In children 6 years and older (n=41), full-scale IQ was significantly lower as were scores on processing speed, attention, learning and memory skills, visuo-motor functioning and executive functioning, compared with normative data. In a small cohort with 23 children, Manglick et al. investigated long-term neurocognitive outcome in children after near drowning who seemed neurologically intact on hospital discharge (44). Assessments were done 3-6 months, 1 year, 3 years and 5 years after near drowning. All children had CPR, except one. In 22% abnormalities in behavior as well as poor communication, executive dysfunction and learning problems were found (44). In summary: Studies describing long-term outcome after OHCA in children are few and only five peer-reviewed studies were published. All above mentioned neuropsychological outcome studies (see table 2) showed lower intelligence scores compared with the norm population. Additionally, as to subdomains, lower scores were found in visual memory, processing speed, attention and executive functions, also compared with norms. Regretfully in some studies, part of neuropsychological assessments were done by telephone interview with parents/caregivers (42, 43). Also, few studies included children with both IHCA and OHCA (5, 43). No structured repeated neuropsychological assessments were done and inclusion criteria were different in all studies. Two studies were cross-sectional (5, 45), both sub-studies of the THAPCA trial had a follow-up interval 1 year post-arrest without repeated measures (42, 43). Only 1