Maayke Hunfeld

188 Chapter 6 normothermia on survival with good neurobehavioral outcome in children 1 year after event. 4. Inclusion period; 2009-2012 in THAPCA versus 2002-2019 in present study. 5. Follow-up interval; 1 year in THAPCA versus cross-sectional with a median of 25 months in present study. Additional cognitive evaluations of the THAPCA cohort were performed by Slomine et al. (25, 26). They found significant neuropsychological and neurobehavioral deficits in initially comatose pOHCA survivors although they were classified one year post- arrest as having favorable neurologic outcome. In addition they observed 3-month outcomes to be predictive of outcomes after 1 year (33). Van Zellem studying in- and out-of-hospital arrests et al. used different IQ tests, neuropsychological tests and questionnaires, incomparable with the PCPC scoring system (23). Lopez-Herce et al. found in 95 children (multicenter, 1998-1999), 17% favorable neurologic outcome after one year (24). Michiels et al. found in a 36-year inclusion period (1976-2007) and a median of 4 years of follow-up, 2% favorable neurologic outcome (22). Both described favorable neurologic outcome as PCPC scores of 1-2. Finally, Suominen et al. studied only arrests caused by drowning between 1985 and 2007 (27). Only 4 of 21 children had no neurologic or cognitive deficit after a median of 8 years of follow-up. What are the implications of the present study? First, shockable rhythm was shown to significantly and relevantly improve odds of true long-term favorable outcome. With favorable outcome defined as PCPC 1-3 the relationship was even stronger. And most notably in children eight years and above, shockable rhythm was statistically significantly associated with favorable outcome with OR 22.7 [11.6-44.8). This can be explained by the relatively high incidence of shockable rhythm in adolescents (aged 12-18 years) (39%). Also young children are less likely to have an AED used during CPR than older children, possibly because arrests are more often occurring at home rather than in public locations where AEDs are available. In a cohort study from an OHCA registry in Japan, the proportion of adults with a favorable neurological outcome 30 days after event was significantly higher in those who received public-access defibrillation than those who did not (845 [37.7%] vs 5676 [22.6%] (34). Our results might implicate that the efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable OHCA at scene and the importance of improvements in the chain of survival (e.g. bystander BLS, public access to and use of AED and adequate EMS response) (35, 36). Second, a remarkable finding was that 81% of survivors to hospital discharge achieved long-term favorable neurologic outcome beyond 1 year. This could be due to the setting in the Netherlands (e.g. high incidence in AED use and bystander CPR, the availability of HEMS 24/7, short transfer time from the scene to the hospital). Another possible explanation could be that in our study cohort the main cause of