Introduction: Improved understanding of the prevalence, cause, and timing of death following out of hospital cardiac arrest (OHCA) may allow us to identify patients who will benefit from future interventions. Methods: We performed a retrospective cohort study of OHCA patients admitted to a tertiary Pediatric Intensive Care Unit from February 2005 to May 2013. Eligible patients were < 18 years of age, received ≥ 1 minute of compressions, and had ROSC > 20 minutes. Using clinician notes, cause of death was classified as brain death (BD) or withdrawal for poor neurologic prognosis (W-NEURO), withdrawal for refractory circulatory failure (W-CV), or re-arrest without ROSC. Vasopressor scores were calculated within 6 hours of admission. Time to death was defined as days from ROSC. Fishers exact test and Kruskal Wallis to test associations. Results: One hundred ninety one OHCA patients were evaluated. The most common arrest causes were respiratory failure (34%) and drowning (21%). Eighty six children (45%) died prior to discharge. Cause of death was W-CV 9 (10%), re-arrest 8 (9%), BD 41 (48%), and W-NEURO 26 (30%). Time to death was earlier for W-CV 1 day [1, 2] and re-arrest 1 day [0.5, 1] vs BD 4 days [2,5] and W-NEURO 4 days [1,5]; (p<0.0005). Patients who died from W-CV versus W-NEURO had a lower pH within 6 hours of arrest (6.98 [6.86, 7.11] vs 7.14 [7.08, 7.29], p=0.03), higher lactate (13.4 [9.2, 18.7] vs 6.6 [4, 14.9], p=0.06), and higher vasopressor scores (110 [50, 170]) vs W-NEURO (5 [0, 20]), p=0.001.) There was no difference in neurologic exam 6 hours post ROSC (non-paralyzed patients) between W-CV vs W-NEURO: absence of pupillary response (6/8 (75%) vs 11/26 (42%), p=0.23), absence of gag reflex (7/7 (100%) v 19/23 (82%), p=0.60), or Glasgow Coma Motor Score < 4 (7/7 (100%) vs 22/23 (96%); p = 0.66). Conclusions: Following resuscitation from OHCA, deaths due brain death (48%) or withdrawal for poor neurologic prognosis (30%) were most common and occurred later after ROSC than death due to cardiovascular causes. Patients with withdrawal for refractory circulatory failure or poor neurologic prognosis had similar early neurologic abnormalities. Understanding factors that impact early clinician neuroprognostication may impact OHCA outcomes.