Maayke Hunfeld

240 Chapter 8 program started in 2012 with the primary goal to provide good care to patients and their caregivers, and boasts a high response rate with few refusals. In chapter 7, the functional and neuropsychological outcomes at 3-6 and 24 months post-OHCA (between 2012-2017) were presented. Of the 49 survivors, respectively 74% and 73% had a good outcome at 3-6 and 24 months post-OHCA, as reflected by a PCPC score 1-2. Only a minority had motor deficits on neurological exam. The majority of school-aged children (81%) went back to school without a change in school level after 24 months. The question arises whether the relatively high percentage of good PCPC scores in our cohort is associated with the high amount of WLST of children due to expected poor neurologic outcome. If so, this may have caused a selection bias. On the other hand, good PCPC scores at hospital discharge are in line with those reported by previous studies (42-44). Worse scores were found on sustained attention and processing speed compared with norm data at both time points. Additionally, at 24 months, worse scores were also found on intellectual functioning, selective attention, and cognitive flexibility compared with norm data. The neuropsychological outcomes of children who underwent neuropsychological testing at both time points had not significant changed over time. Only few studies have been published regarding the long-term neuropsychological outcome in children after OHCA (see introduction of this thesis). Slomine et al. described the neuropsychological outcomes of 160 children after CA (45), and likewise found worse intelligence scores and worse scores on attention, cognitive flexibility and processing speed (all compared with normative data). This is remarkable, since our study differed in some aspects from the study of Slomine and colleagues: 1. Slomine and colleagues retrieved outcomes from the THAPCA trial – a randomized trial comparing the efficacy of therapeutic hypothermia with that of normothermia on survival. 2. In the THAPCA trial, children were included after both IHCA and OHCA and when they were unresponsive and mechanically ventilated after ROC, creating a population with possibly more severely affected children. 3. Moreover, the follow-up interval in the THAPCA trial was cross sectional at 1 year versus longitudinal (with repeated onsite visits with repeated measures) up to 2 years in our study. The pathophysiological mechanisms underlying the neuropsychological deficits in children post-CA are not completely understood. The question is whether neuropsychological deficits are fully explained by the areas of the brain that have been damaged due to ischemia.