Clinical paperLong-term prognosis after out-of-hospital cardiac arrest☆
Introduction
The chance of survival after out-of-hospital cardiac arrest (OHCA) varies between 2% and 49% but it depends upon co-morbidity, initial ECG-rhythm, bystander cardiopulmonary resuscitation (CPR), and also the emergency medical system (EMS).1, 2, 3 Initial survival to discharge from hospital, however, may not be considered as the most appropriate way to assess outcome because brain dysfunction may seriously affect quality of life. In addition, mortality is high in the first few months after hospital discharge. It is therefore much more relevant to report outcome after OHCA as late survival, including an assessment of neurological status and quality of life. Previous studies of long-term prognosis and quality of life after OHCA have been associated with important limitations such as inclusion of patients over long periods of time and incomplete follow-up.
In this study we aimed to report survival beyond 6 months including quality of life for a well-defined cohort of OHCA victims prospectively recorded in 2 consecutive years for a physician-based EMS in an urban area.
Section snippets
Methods
In this prospective study we collected data related to OHCA during a 2-year period from 1 June 2002 to 31 May 2004. We included all emergency calls classified as OHCA where the Mobile Emergency Care Unit (MECU) was dispatched. We excluded cases where obvious signs of death were found. The Ethical Committee in Copenhagen and Frederiksberg County approved the study.
Data according to the Utstein criteria were collected by the attending specialist in anaesthesiology at the MECU and recorded on a
Results
In the period of evaluation the dispatch centre had 18,149 emergency contacts leading to dispatch of the MECU, 1010 were related to OHCA and we had data on 984 cases, 579 men and 405 women. The median age was 71 years (34–91 years) and the aetiology was presumed cardiac in 792 (80.5%) cases and non-cardiac in 192. Non-cardiac causes were trauma, intoxication, drowning, exsanguination, suffocation, suicide, cot death, and cerebral causes. Time from collapse to 112-alarm was not recorded. The
Discussion
We found that 12.3% survived beyond 6 months after OHCA in a physician-based EMS. Follow-up examination was performed in 33 patients out of those 63 survivors. Summary scores of quality of life were not significantly different from the national norm, but 2 out of 8 subscores were lower. Signs of dementia were uncommon as only 6% had a low MMSE score and most patients had an MMSE above 28.
The study group included nearly all cases of OHCA during 2 consecutive years and due to the national
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2006.06.029.