Clinical paperPredictors of long-term functional outcome and health-related quality of life after out-of-hospital cardiac arrest☆
Introduction
Due to anoxo-ischemic damages, brain injury is the most common cause of early death in patients resuscitated from cardiac arrest.1 This is in contrast with what is observed in survivors, as a large majority of these patients appear to have a good neurological outcome with no important sequellae using common performance scales.2 Whether health-related quality of life (HRQOL) is or not altered in these survivors is less explored, even if it is now considered as a major outcome criteria.3 Recent data reported that a substantial proportion of cardiac arrest survivors suffer from impairment not detected previously by standard outcome scales, suggesting that a subgroup of survivors does not regain an acceptable quality of life during the longer-term period following a cardiac arrest.4, 5 In addition to the devastating impact on the patients and families’ daily life, alteration in quality of life may have consequences in broader socioeconomic terms, due to potential loss of productivity. Quality of life might be altered for numerous reasons in cardiac arrest survivors and identification of long term determinants of HRQOL could help to tailor interventions designed to prevent deterioration.
Anoxia-related brain injury is the most important determinant of HRQOL in survivors.2 Due to the multiple constructs that are included in the concept of HRQOL, such as perceived health status, functional status as well as social interactions and symptoms, such an outcome should be preferred to accurately evaluate brain damage long-term consequences.3 However the specific role of some determinants, such as recovery of daily-life autonomy and professional reinsertion, deserve investigation. In addition, it is unclear if complete neurological recovery, as assessed through common performance scales, is consistently associated with a better HRQOL. Among survivors with apparent complete recovery, there might be some heterogeneity in the pattern of HRQOL, and initial management may influence these patterns of HRQOL, if any.
By using the Parisian cohort, our aims were three fold: firstly, we evaluated the long-term HRQOL of cardiac arrest survivors and compared it with matched individuals from the general population, taking into account the level of neurological recovery. Secondly, we identified factors associated with a better long-term HRQOL. Thirdly, among survivors with apparent complete neurological recovery, we searched for the existence of different patterns of long-term HRQOL using a cluster analysis.
Section snippets
OHCA patients’ management
The pre-hospital management of OHCA patients in the suburban Paris area (France) and their subsequent in-hospital management have been previously described.6, 7 Briefly current management of OHCA patients involves mobile emergency units and fire departments. Patients in whom return of spontaneous circulation (ROSC) is achieved are then referred to a tertiary “cardiac arrest center” with an intensive care unit (ICU) and coronary intervention facilities available 24 h a day, 7 days a week.
Study population
Among the 1829 successfully resuscitated patients admitted alive to the ICU, 1228 died during ICU stay and 601 were discharged alive from ICU. Among discharged patients, 136 had died at time of evaluation and 210 patients were lost of follow-up, leaving 255 patients for interview. Patients who were lost of follow-up had similar pre hospital characteristics and CPC at hospital discharge than patients who were interviewed except that cardiac arrest was less frequently witnessed and that they were
Discussion
In these OHCA survivors interviewed 50 months after their cardiac arrest, we firstly demonstrated that HRQOL as assessed by the SF-36 was dependent of the level of neurological recovery: while in patients with complete neurological recovery HRQOL was not different than that of age and gender-matched controls from the general population, in patients with incomplete neurological recovery, deep alterations were noted in almost all dimensions of the SF-36 as compared to their controls from the
Conflict of interest statement
None.
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Cited by (0)
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2017.01.028.
- 1
FD and GG are co-first authors.
- 2
JPE and AC are co-last authors.