Maayke Hunfeld

263 Summary/samenvatting The study presented in chapter 4 explored the timing and cause of death in 113 children admitted to our PICU following return of circulation (ROC) after OHCA between 2012 and 2017. Fifty-one children survived to hospital discharge. Of the 62 non-survivors, causes of death were: brain death (BD) (18/62), WLST due to poor neurologic prognosis (WLST-neuro) (42/62), WLST due to refractory circulatory and/or respiratory failure (1/62) and recurrent CA (1/62). Compared with non-survivors, survivors had more witnessed arrest, more initial shockable rhythm, shorter cardiopulmonary resuscitation (CPR) duration and more favorable clinical neurological exam within 24h after PICU admission. Basic, CPR-event and post-ROC (except for number of Extracorporeal membrane oxygenation (ECMO)) characteristics did not significantly differ between WLST-Neuro and BD patients. Timing of decision making to WLST due to poor neurological prognosis ranged from 0 to 18 days (median 0 days). The decision to WLST was based on neurologic exam (100%), electroencephalography (44%) and/ or brain imaging (35%). The purpose of the study in chapter 5 was to examine whether early brain MRI including diffusion weighted imaging (DWI) predicts neurological outcome at hospital discharge and two years post-OHCA in children. Forty children, admitted to our PICU after OHCA between 2012-2017, who received MRI within 1 week post-OHCA were included in the study. We showed that a normal brain MRI (without post-hypoxic injury) on T1/T2 weighted images and DWI within 1 week after pediatric OHCA was 100% predictive for a good neurological outcome at 2 years post-OHCA. Conversely, the presence of extensive injury ( ≥ 50% of the cortex/white matter or in 4 or more defined brain regions (with or without involvement of deep grey matter)) on T1/T2 and DWI was 100% predictive for a poor neurological outcome or death at hospital discharge and 2 years post-OHCA. However, solely based on MRI with focal injury (<50% of the brain), it was impossible to predict neurological outcome accurately at hospital discharge or 2 years post-OHCA. In Chapter 6 we investigated the association between first documented rhythm and long-term outcomes in a pediatric OHCA cohort over 18 years. Three-hundred- sixty children who experienced OHCA between 2002-2019 and subsequently admitted to our emergency department or PICU were included. Fourteen percent of the total cohort had a shockable rhythm, in adolescents (aged 12-18 years) this was 39%. Thirty-nine percent survived to hospital discharge. On median follow-up interval of 25 months, 81% of hospital survivors had a favorable neurologic outcome. Shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. 9