Maayke Hunfeld

184 Chapter 6 Outcome: ROSC, SHD, long-term outcome Of the final sample of 360 children, 142 (39%) survived until hospital discharge, whereas 218 (61%) died in the ED (no ROSC, 102, 28%) or during hospital admission (116, 32%). The main cause of in-hospital mortality after ROSC was withdrawal of life-sustaining therapy (WLST) (76 children, 21%). Of the 142 survivors to hospital discharge, 7 (5%) died after discharge; 6 due to severe hypoxic encephalopathy, 1 cause unknown. The median follow-up duration was 25 months (IQR 5.1 - 49.6) and median age at follow-up was 6.6 years (IQR 3.4 - 13.4) (table 1). 89 of 142 children (63%) had a follow-up duration of longer than 1 year post-arrest. Table 2 shows timing and source of the long-term neurological outcome. PCPC scores are presented per category (1-6) and FSS scores as median. PCPC scores were mostly scored either at regular hospital visit (n = 47) or at prospective follow-up (n = 46). Except for the group scored at hospital discharge, median follow-up duration for the other groups exceeded 2 years (regular hospital visit 2.7 years [IQR: 0.8-5.5]; cross- sectional 3.7 [IQR 2.5 – 10.5] and prospective 2.3 years [IQR 1.1 – 3.8]. Favorable outcome versus non-favorable outcome A higher SES score, bystander BLS, shorter CPR duration, rhythm (shockable or unknown), cause of arrest (arrhythmia, drowning, shock and seizures), lower first pH, higher lactate and ROSC before arrival to hospital were all significantly associated with favorable neurologic outcome (table 1). Multivariable analysis The crude associations were adjusted for witnessed arrest, bystander CPR, age at arrest, year of arrest, first lactate, pre-existing conditions related to arrest and CPR duration. After adjustment, first documented shockable rhythm showed significantly improved odds of favorable outcome compared with non-shockable rhythm, with an OR of 8.9 [95% CI 3.1-25.9] (table 3). Also, first documented unknown rhythm (OR 6.1 [95% CI 2.2-16.5]), a more recent year of arrest (OR 1.2 [95% CI 1.1-1.2]) and the post-guideline change period (advising AED use in all ages) (2010-2017) (OR 2.6 [95% CI 1.3-5.1]) showed significantly improved odds of favorable outcome. In the sensitivity analysis with PCPC 1-3, first documented shockable rhythm showed a stronger relationship with favorable outcome than favorable outcome defined as PCPC 1-2 (OR 13.7 [95% CI 4.6-40.9]).