Maayke Hunfeld

176 Chapter 6 hospital and Helicopter Emergency Medical Service (HEMS) provide health care in the southwest of the Netherlands with approximately five million inhabitants, about 25% of the Dutch population. The Medical Ethics Review Board of the Erasmus MC approved the data collection and gave a waiver for the requirement of informed consent (MEC-2019-0440). Inclusion criteria All children aged 24 hours to 18 years with non-traumatic pOHCA, admitted to the Erasmus MC - Sophia Children’s Hospital (ED or PICU) with or without CPR in progress between January 2002 and August 2019 were included. Arrests in neonates younger than 24 hours were excluded as they are generally caused by perinatal asphyxia. CA was defined as the need for chest compressions for at least one minute. Cardiopulmonary resuscitation was defined as ‘basic life support’, in line with the European Resuscitation Council Guidelines, and if needed, followed by ‘advanced pediatric life support’ (APLS) (5). Data collection Existing CPR databases were used to combine CPR data from 2002 until 2019 (23, 28). All CPR data were derived from ground ambulance records, HEMS records and hospital health record systems. Because HEMS are always deployed in the Netherlands in (suspected) pOHCA, all HEMS records between 2002 and 2019 were also analysed to get an insight of pre-hospital mortality and potential transport to other hospitals. In some rare cases of conflict between data sources (ground EMS and HEMS) HEMS data was used as golden standard. Our CPR data is primarily based on two already existing CPR databases derived from ground EMS CPR data, HEMS data and health record systems from our hospital. In addition HEMS records were analyzed to report pre-hospital mortality and alternate destination. Data included: A) basic child characteristics (age, gender, parent’s Social Economic Status (SES), pre-existing health status). The SES was calculated using a ‘Status Score’ divided into tertiles to interpret a ‘low status (1)’, ‘intermediate status (2)’ and ‘high status (3)’ (29). The ‘Status Score’ is based on income, education level and unemployment rate by postal code. B) OHCA characteristics (year, location, first documented rhythm (shockable/non-shockable or unknown), witnessed, cause, bystander CPR, use of AED, CPR duration, extracorporeal CPR (ECPR), targeted temperature management, first blood lactate and pH after ROSC or at hospital arrival,