Maayke Hunfeld

242 Chapter 8 of invasive procedures, temperature management and the occurrence of hyperoxia or hypotension) (8, 61-63). All these factors make it a complex interplay and makes comparison of our study with the THAPCA trial difficult. Regarding the neuropsychological outcomes 3-6 months after OHCA, a selection bias may have occurred because we found a trend ( p =0.07) towards more favorable PCPC scores in the neuropsychologically tested group compared with the non- tested group. Therefore the finding that OHCA children scored worse on sustained attention and processing speed and not on other outcomes at this time point should be interpreted with caution. Consequently, a neuropsychological assessment at 3-6 months post-arrest may be not yet fully reliable or possible, because children are then still recovering from their OHCA. However, from a care point of view it can be very useful to detect a child strengths and deficits at this time point, because these provide an indication for need of a patient-targeted rehabilitation treatment. Although the gross outcome during follow-up was good in our OHCA cohort, children generally did have deficits at 24 months post-arrest, making them cognitively vulnerable during development. What does this mean for the future of these children? This is difficult to predict from our study, for one thing because the median age in our small cohort was 48 months at the time of arrest, with a wide range of 3 months up to 18 years. Besides, the long-term impact on their academic career and participation in daily life is still unclear. From follow-up studies in other children with acquired brain injury (e.g. TBI or brain tumor), we know that these children may grow into deficit over time (64-67). This means that follow-up over a longer time span is needed to gain more insight in these aspects. An international standardized follow-up program is lacking, and so are follow-up studies examining long-term outcome after OHCA in adulthood. What is ’good’ outcome? In our cohort, almost three quarters of survivors had a PCPC score of 1 or 2 years post- arrest, which is considered a ‘good’ outcome. Still, we believe that the definition of a good outcome is more than only a crude functional measure such as a PCPC. A PCPC score does not reflect QoL or participation of patients and their parents and families. The prediction of long-term neurological outcome in children with severe acute brain injury is one of the most difficult tasks pediatric neurologists and intensivists encounter. They are challenged to provide parents with the most accurate prognosis possible. A too optimistic prediction can unexpectedly result in survival of a child with severe, devastating neurological deficits. On the other hand, a too pessimistic prediction may lead to unnecessary WLST in a child with a potential good outcome. Clinicians aim to predict outcome after OHCA in an early stage, but why? Knowing in an early stage that the outcome on the short and long-term is ‘good’, takes away the