Elsevier

Resuscitation

Volume 80, Issue 5, May 2009, Pages 517-522
Resuscitation

Clinical paper
Life after survival: Long-term daily functioning and quality of life after an out-of-hospital cardiac arrest*

https://doi.org/10.1016/j.resuscitation.2009.01.020Get rights and content

Abstract

Background

Information about long-term consequences of cardiac arrest is sparse. Because the survival rate is expected to increase, better knowledge of long-term functioning and quality of survival is essential.

Objectives

To determine the level of functioning of out-of-hospital cardiac arrest survivors 1–6 years later, and to evaluate the predictive value of medical variables on long-term functioning.

Methods

A retrospective cohort study including 63 survivors of an out-of-hospital cardiac arrest, admitted to a Dutch University hospital between 2001 and 2006. Participants received a questionnaire by post. Primary outcome measures were: participation in society (Community Integration Questionnaire) and quality of life (SF-36). Secondary outcome measures were: physical, cognitive and emotional impairment, daily functioning and caregiver strain. Statistical analyses included multiple regression analyses.

Results

On average 3 years post-cardiac arrest, 74% of the patients experienced a low participation level in society compared with the general population. Over 50% reported severe fatigue, 38% feelings of anxiety and/or depression and 24% a decreased quality of life. Caregivers reported stress related responses, feelings of anxiety and lower quality of life. Seventeen percent of the caregivers reported high caregiver strain, which was associated with the patient's level of functioning. Gender, age, percutaneous coronary intervention (PCI) and therapeutic hypothermia contributed to outcome on at least one domain of long-term functioning.

Conclusions

After surviving an out-of-hospital cardiac arrest, many patients and partners encounter extensive impairments in their level of functioning and quality of life. Gender, age, PCI and therapeutic hypothermia are associated with differences in long-term functioning of patients.

Introduction

In the Netherlands, the overall incidence of sudden cardiac death is 0.92 per 1000 persons per year.1 Reported survival after an out-of-hospital cardiac arrest is between 2% and 23% of patients with a bystander-witnessed cardiac arrest surviving to discharge.2 However, this number is expected to increase with the increasing availability of automated external defibrillators (AEDs).3

During a cardiac arrest, the brain suffers hypoxia which may cause diffuse ischemic–hypoxic injury that may result in cognitive deficits.4 Six months after the cardiac arrest, cognitive deficits are still present in up to half of all survivors.5 Hypoxic brain injury also has an impact on other important aspects of life. Survivors report symptoms of depression,6 dependency on others for daily functioning,6 decreased participation in society with only 13–58% of patients returning to work,7, 8, 9 and a lower quality of life.6, 7

Research on prognostic factors for surviving a cardiac arrest showed that among predictors of a poor neurological outcome are older age, unwitnessed arrest, lack of bystander cardiopulmonary resuscitation (CPR),10 a non-VT/VF initial cardiac rhythm and a long interval between collapse and return of spontaneous circulation.10, 11 However, little is known concerning prognostic factors of long-term functioning and quality of life of cardiac arrest survivors. This information could help clinicians to inform their patient and family members about future problems and functioning, and possibly guide intervention in the early stages.

In this study we determined the level of participation in society, quality of life, cognitive, emotional and physical impairment, and daily functioning of out-of-hospital cardiac arrest survivors, and strain on, basic functioning and quality of life of their caregivers several years after the event. The hypothesis was that out-of-hospital cardiac arrest survivors have lower levels of functioning on all domains compared with the general population, and that caregiver strain is augmented. Second, we studied prognostic factors for participation in society, quality of life, cognitive impairment and daily functioning after surviving a cardiac arrest. We hypothesized that the interval between collapse and return of spontaneous circulation,10, 11 application of mild therapeutic hypothermia12, 13 and Implantable Cardioverter Defibrillator (ICD) placement14, 15 would all be associated with level of outcome in one or more of these domains.

Section snippets

Study population

Out-of-hospital cardiac arrest survivors who had been admitted to the Department of Cardiology of the University Hospital Maastricht, the Netherlands from January 2001 till December 2006 were asked to participate in this retrospective cohort study. The hospital is the primary referral centre for a catchment area of approximately 200,000 inhabitants covered by a single ambulance service. Participants were survivors aged 18 years or older, still alive at the time of the study, and with sufficient

Results

As shown in Fig. 1, 220 persons with a possible out-of-hospital cardiac arrest were identified. Due to exclusion, death and loss-to-follow up, 88 persons were eligible for participation in the study. Sixty-three (72%) patients, 54 men and 9 women, with a mean (S.D.) age of 60.2 (±12.7) years, and 42 caregivers participated.

The mean (S.D.) time since cardiac arrest was 36 (±18.8) months. No statistically significant gender- (t = −0.62, p = 0.54) or age-related (Chi-square = 0.04, p = 0.84) differences

Discussion

We found that many patients surviving 6 months to 6 years after an out-of-hospital cardiac arrest experienced severe fatigue, feelings of anxiety and depression, cognitive problems and a decreased quality of life. They also had problems with participation in society. These results can be compared to functioning in the general population, but also to other studies focusing on cardiac arrest survivors or brain-injured patients.

In comparison with the general population, patients in this study seem

Conclusions

Our results indicate that after surviving an out-of-hospital cardiac arrest, both patients and partners can experience important impairments in their lives, similar to those seen in patients with other kinds of brain damage. This might suggest that, in order to improve their quality of life, survivors of cardiac arrest should receive additional therapy similar to patients with other brain injuries rather than regarding them as cardiac patients only. It also shows the need and importance of

Conflict of interest

None declared.

Acknowledgements

The authors want to thank Drs. B.J.W. Eikemans, J.P.J.M. de Munter, M. de Munter and J. Partouns for providing the majority of the medical data of the participants, and for the effort they put in the study. We also want to thank the participants for their participation and useful comments.

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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.2009.01.020.

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