Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment
Introduction
In recent years efforts in emergency care have improved survival after cardiac arrest outside the hospital, with survival rates varying from 10–33% [1]. Moderate to severe neuropsychological sequelae were found in approximately one half of the survivors after 1 year [2]. For this subgroup of cardiac arrest (CA) survivors and their families, ‘success’ by the resuscitation team does not necessarily mean long-term success. Prolonged cerebral anoxia causes damage to the cortex and basal ganglia, leading to physical, cognitive and behavioural impairment [3], [4]. Only a few studies focus on the nature and severity of complex neuropsychological deficits after cerebral anoxia, reporting a high prevalence of deficits in memory and executive function as well as depression and anxiety [2], [5], [6], [7]. Studies on quality of life are up-to-date, but their findings have several shortcomings for CA survivors. Different settings of cardiopulmonary resuscitation (CPR) are not comparable with respect to outcome [8], and some patients have limited introspective capacities due to cognitive impairment, making their statements on quality of life debatable [9]. In our experience, the accuracy and reliability of outcome assessments are increased by personal meeting with patients and caregivers [10], [11]. In traumatic brain injury survivors, for example, there is a strong direct relationship between personality change and the subjective burden of care in families, while physical impairment was less stressful [12]. In stroke rehabilitation, studies on the coping abilities and social support of carers confirmed the impact of psychosocial support at the intersection between institutional and home care [13].
This study assessed the long-term outcome of CA survivors after inpatient rehabilitation. Objectives were to determine typical permanent cognitive profiles, to assess the functional impact of anoxic brain injury, to compare self and proxy rating of persisting disabilities, and to describe the life situation of survivors and their families.
Section snippets
Patients
Between July 1991 and July 1999, 33 patients with anoxic brain damage (ICD-9 code 310.1 and 348.1) underwent prolonged inpatient rehabilitation at the University Hospital of Vienna. Patients in persistent vegetative state (N=2), patients after in-hospital CPR (N=3), and patients with non-cardiac origin of cerebral anoxia (N=7) were excluded [14]. The remaining 21 survivors of out-of-hospital CA were sent a mailed invitation for a follow-up examination together with their partner or carer.
Results
Among 12 CA survivors attending interdisciplinary assessment, two individuals were unable to participate in neuropsychological tests and self report questionnaires, due to severe physical and communicative impairment. Ten patients had adequate verbal comprehension of test instructions. Ten patients were accompanied by ten family members (eight wives, one husband and one mother).
Discussion
This study highlights the life situation of CA survivors sustaining anoxic brain damage and their families after cessation of comprehensive rehabilitative treatment. Thus, this small but well-documented sample represented a selected group of anoxic patients having undergone optimal care after CA. Short verbal information on the six patients who refused to participate the study showed that their life situation did not differ from those presented here. In these twelve patients anoxic brain damage
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What are the care needs of families experiencing cardiac arrest?: A survivor and family led scoping review
2021, ResuscitationCitation Excerpt :A total of 397 family member interviews informed our findings. The cardiac arrest location was reported in 31 of the studies: 16 out-of-hospital cardiac arrest studies (OHCA) (52%),5,35,37–38,43–44,47–48,50–52,55–57,60,62 9 in-hospital cardiac arrest studies (IHCA)(26%)27–29,33,36,38,58,61,63 and 7 studies reported both OHCA and IHCA (18%)6,9,26,30,34,53–54. The aetiology of cardiac arrest was described in 13 of the studies: six medical (46%),28,30,31,39,52,61 one traumatic (8%),34 and six studies (46%) of mixed aetiology.5,9,33,54,62,63