The first year after successful cardiac resuscitation:: Function, activity, participation and quality of life☆
Introduction
Out-of-hospital cardiac arrest is associated with high mortality. In Göteborg between 1980 and 1992, 3434 persons suffered an out-of-hospital cardiac arrest. Of these, 707 arrived at the hospital alive and 278 of them were subsequently discharged. Of those who died in hospital, almost 90% suffered from brain damage, and about 55% of those who were discharged alive experienced good cerebral recovery [1]. Roine et al. [2] followed patients admitted consecutively in a double-blind study of nimodipine treatment in out-of-hospital ventricular fibrillation. The patients were followed until 1 year after cardiac arrest, and neuropsychological factors, among other things, were evaluated both by using a simple questionnaire and by qualified neurophysiologists. They noted cognitive problems in approximately 50% of the 54 survivors [2]. In a retrospective study in Göteborg [3] of 40 patients after successful cardio-pulmonary resuscitation (CPR), cognitive problems were present in one-third of the patients, after more than 2 years of the incident. Cognitive problems that are detected by a test is one thing and the capacity to function in daily life is another. Rosen et al. [4] reported the ADL function 1 year after cardiac arrest in a prospective study. They found that more than 20% persons were dependent on others. This was higher than in the previous study [3], where 15% were identified as dependent, using the same ADL instrument for evaluation.
The World Health Organization has launched a classification system called the International Classification of Functioning, Disability and Health (ICF) [5] in order to provide a scientific basis for understanding health and outcomes in a broad context.
In the context of survivors of CPR, this leads to a focus, not only on survival or non-survival, but also on the consequences of the incident on activity level, such as activities of daily living (ADL) or finding the way home, participation (capable of returning to work, able to participate in recreational activities) and environmental factors (living at home or having to live in sheltered accommodation).
The aim of this study was to follow survivors after CPR longitudinally for up to 1 year with the focus on cognitive function, ADL capacity and living situation.
Section snippets
Material and methods
A sample of cardiac arrest survivors between the ages of 18 and 75 years was gathered over a course of 3 years (1996–1999). To find the patients, we called the emergency wards, the coronary care units and the intensive care units, once a week. To be included as a survivor, the person had to be alive when he/she was identified, and known to have been capable of communicating in Swedish. Information about the study was given both to patients and their next of kin, and the latter gave their
Results
The mean age at the time of the cardiac arrest was 60 years (22–75 years). Twelve persons died within the first 2-week period from the cardiac arrest, and three more died within the first 45 days. The mean ROSC was 11 min (1–35 min). All 12 individuals who had 15 points or more on the NIHSS (indication of severe brain injury) at the first examination died within the first 45-day period. Mortality within the first 90 days was 31% (16 persons), while after discharge, it was only 8% (3 persons). The
Discussion
As expected, indications of severe brain injury were an indicator of mortality. There are two time limits of importance in this study. First is the importance of the early screening of brain injury to predict mortality within the first 45 days. The second is the cognitive function and ADL capacity at 45 days, since, even if cognitive tests might indicate an improvement and this is not always accompanied by a reduction in dependency level in everyday activities. These time limits show that the
Conclusions
The study shows both positive and negative results at 1 year post-cardiac arrest with only two outcomes; doing well or having problems. Those that are dependent on ADL (about half the population) have reduced cognitive function. It is therefore important to assess survivors in order to identify those in need of assistance and further rehabilitation, since not much improvement occurs.
Acknowledgements
This study was supported in part by a “Stimulansbidrag” (stimulation grant) from the Swedish National Board of Health and Welfare (Socialstyrelsen). Support was also given by the Laerdal Foundation, the Swedish Heart and Lung Foundation, the Handicap Committee of Västra Götaland, the Swedish Medical Society (Olle Höök's foundation), the Stohnes Foundation, Axel Linder's Foundation, the Research Foundation at Sahlgrenska University Hospital, Hjalmar Svensson's Foundation and Willhelm and Martina
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A Spanish translated version of the Abstract and Keywords of this article appears as an Appendix at 10.1016/j.resuscitation.2005.04.001.