Maayke Hunfeld

175 Shockable rhythm and outcome Introduction Pediatric out of hospital cardiac arrest (pOHCA) is uncommon, with incidences ranging from 9.0 – 19.7 per 100,000 person-years (1-4). Whereas CA in adults is mostly of cardiac origin, in pediatrics it is commonly due to respiratory failure (5). Survival following pOHCA is poor, especially among infants (6, 7), but increasing due to ‘chain-of-survival’ improvements (7-13). Children receive more bystander basic life support (BLS), more automated external defibrillators (AED’s) are available and post-return of spontaneous circulation (ROSC) care has improved, despite AED use in children remaining low (6, 7, 9, 13, 14). Shockable rhythms in children seem more common than once thought (15, 16), especially in adolescents with a prevalence of 19% (7). The positive association between shockable rhythm and short-term outcomes (ROSC, survival to hospital discharge (SHD) and outcome up to 1 year) has been reported but true long-term follow-up (> 1 year after event) is lacking (6, 17) . Is increased short-term survival rate after pOHCA associated with more children with severe long-term neurological sequelae due to hypoxic ischemic brain injury (18-20)? To be able to detect a child’s full potential (neurologic) recovery, a statement from the American Heart Association recently recommended one year of follow-up minimally (21). Literature on outcomes beyond one-year following pOHCA is scarce, often small in sample size, using different and mostly crude measurements and mainly based on data prior to 2008 (17, 22-27). Since 2012 the Erasmus MC – Sophia Children’s Hospital has a long-term follow-up program including all pOHCA, as part of standard of care, which led to the following subjective observations: 1) the incidence of shockable rhythms increased over time and 2) shockable pOHCA’s achieve favorable long-term neurological outcome more frequently compared with non-shockable pOHCA’s. The aim of this study was to investigate the association of first documented cardiac arrest (CA) rhythm on true long-term outcome in non-traumatic pOHCA. We hypothesized that a shockable rhythm was positively associated with survival with long-term favorable neurologic outcome. Methods Study Design This cohort study was performed at the PICU of the Erasmus MC – Sophia Children’s Hospital, a tertiary-care university children’s hospital in the Netherlands. The 6