Maayke Hunfeld

189 Shockable rhythm and outcome in-hospital mortality after ROSC was WLST (21%), probably due to poor neurologic prognosis. Less WLST could lead to higher survival to discharge numbers, but with more severe neurologically damaged children surviving long-term. Accurate neurological prognostication in a comatose child after OHCA remains challenging and no international pediatric guidelines exist (21, 37, 38). Potentially inaccurate prognostication and WLST may bias outcome (37, 39-40). Third, the median age at time of follow-up was 6.6 years (IQR 3.4-13.4), which is relatively young in childhood and thus growing into deficits might not yet be present. Moreover, neurologic outcome was measured by PCPC, which is a crude outcome scale ranging from 1 to 6 (from no disabilities to brain death). It is unknown whether PCPC reflected how these children function in daily life and if it was associated with detailed neuropsychological functioning. In our opinion, it is crucial to identify how these pOHCA survivors will function on different physical and neuropsychological domains when reaching adolescence or young adulthood. Will they be able to live independently and happy, have a job and start a family? The importance to understand the influence of an arrest on long-term education and development as children grow into adulthood seems clear (21). True long-term follow-up is time and resource consuming, with the potential of losing children to follow-up (21). Long-term follow-up outpatient clinics have to be set up also beyond the 18 year boundary to support this group in maximizing outcome. Our study has several limitations. First, it was an observational, retrospective single center study. Secondly, there were missing data due to the incomplete documentation of the CPR-event (e.g. CPR duration), which required imputation in up to 10% of the data. We minimized this potential bias by doing supplemental analyses with and without imputation. Additionally, we were not able to report and correct for some important CPR characteristics (e.g. quality of CPR, post-ROSC care). Finally, our study is not a complete regional or national pOHCA study since only children admitted to our hospital (with or without CPR in progress) were included. This could have led to selection bias by not including those children who died at scene or transferred to another hospital. Conclusion Shockable pOHCA had an almost nine times higher odds of long-term favorable neurologic survival compared to non-shockable rhythm, adjusted for confounding. The overall SHD after pOHCA was 39% over the 18-year study period, of which 81% of survivors achieved long-term (median 25 months, IQR 5.1-49.6) favorable neurologic 6