Maayke Hunfeld

146 Chapter 5 Abstract Purpose Determine the predictive value of brain MRI findings within 1 week after pediatric out-of-hospital cardiac arrest (OHCA) Methods Retrospective single center study including children (0-17 years) with OHCA, admitted to the PICU of a tertiary care hospital between 2012 and 2017, who received brain-MRI within 1 week post-OHCA. Brain MRI (1.5 Tesla, General Electric Healthcare, Milwaukee, USA) images were analyzed by 2 experienced, blinded neuroradiologists. A neuroimaging scoring system was designed, using T1-, T2- and diffusion-weighted images (DWI). Pediatric cerebral performance category (PCPC) scores were determined at hospital discharge and 2 years post-OHCA. Results Forty children met the inclusion criteria. Median age at time of OHCA was 57 months (IQR 9-172 months), 68% were male. Brain MRI was obtained with a median of 4 days post-OHCA [IQR 3-5 days]. Normal MRI findings were strongly associated with good outcome 2 years post-OHCA, with a negative predictive value of 100% (n=13/13). The presence of extensive brain injury ( ≥ 50% of the cortex/white matter or in 4 or more defined brain regions with or without involvement of deep grey matter) was strongly associated with poor outcome and death at discharge (n=14/14) and 2 years post-OHCA (n=12/12), with a positive predictive value of 100%. Conclusions A normal brain MRI within 1 week post-OHCA is predictive for good neurological outcome 2 years post-OHCA. Conversely, the presence of extensive brain injury on MRI of the brain within 1 week post-OHCA predicts a poor neurological outcome or death at discharge and 2 years later.