Elsevier

Resuscitation

Volume 129, August 2018, Pages 19-23
Resuscitation

Clinical paper
Surviving out-of-hospital cardiac arrest: The neurological and functional outcome and health-related quality of life one year later,☆☆

https://doi.org/10.1016/j.resuscitation.2018.05.011Get rights and content

Abstract

Background

Data on long-term functional outcome and quality of life (QoL) after out-of-hospital cardiac arrest (OHCA) are limited. We assessed long-term functional outcome and health-related QoL of OHCA survivors regardless of arrest aetiology.

Methods

All adult unconscious OHCA patients treated in 21 Finnish ICUs between March 2010 and February 2011 were followed. Barthel Index (BI), activities of daily living (ADL), accommodation, help needed and received, working status, car driving and self-experienced cognitive deficits were assessed in 1-year survivors (N = 206, 40.9% of the original FINNRESUSCI cohort) with a structured telephone interview. Health-related QoL and more complex ADL-functions were evaluated by EQ-5D and instrumental ADL questionnaires.

Results

Good outcome, defined as Cerebral Performance Categories 1 or 2, had been reached by 90.3% of survivors. The median BI score was 100, and 91.3% of survivors were independent in basic ADL-functions. The great majority of survivors were living at home, only 8.7% lived in a sheltered home or needed institutionalized care. Of home-living survivors 71.4% scored high in instrumental ADL assessment. The majority (72.6%) of survivors who were working previously had returned to work. Health-related QoL was similar as in age- and gender-adjusted Finnish population.

Conclusions

Long-term functional outcome was good in over 90% of patients surviving OHCA, with health-related quality of life similar to that of an age and gender matched population.

Introduction

Survival after out-of-hospital cardiac arrest (OHCA) has improved in many countries during the last decade [[1], [2], [3], [4], [5]]. With improved survival, the goal of treatment has shifted to emphasize favourable neurological and functional outcome as well as good quality of life in cardiac arrest patients. Recently patient-reported outcomes and health-related quality of life (HRQoL) were included as supplemental outcomes in the standardized Utstein Resuscitation Registry Templates for OHCA [6]. Data on OHCA survivors’ functional outcome one year after the CA are still limited [7,8], partly because of the challenge of such long-term follow-up. The objective of this prospective observational study was to evaluate the functional status and HRQoL of one-year survivors of the FINNRESUSCI cohort [9], a nationwide cohort of adult unconscious out-of-hospital cardiac arrest patients admitted to Finnish intensive care units during one year, 2010–2011. We specifically aimed to assess the proportion of cardiac arrest survivors living at home one year after the incident, the functional outcome of survivors regarding independency in Instrumental Activities in Daily Living (IADL) functions, activities outside home, return to previous work, car driving, and their self-rated HRQoL.

Section snippets

Methods

This was a prospective observational study. Twenty-one Finnish ICUs treating OHCA-patients participated the study, with referral areas covering approximately 98% of the Finnish adult population (4.3 million www.stat.fi). All participating ICUs belong to the Finnish Intensive Care Consortium. This is a nationwide database including 22 ICUs in Finland which collects data on all ICU treated patients including severity of illness and treatment intensity. Between March 1st, 2010 and February 28th,

Results

The survival and dichotomized CPC outcome data of the FINNRESUSCI study have been published previously [9]. Of the 504 patients in the FINNRESUSCI cohort, 213 (42.3%) survived to one year. Survival data, or one-year outcome data could not be accessed for two (of four) survivors living abroad. One-year functional outcome data could not be assessed in seven survivors known to be alive; six could not be reached by phone despite numerous attempts and one refused to participate in the follow-up

Discussion

In our study nine out of ten one-year survivors of ICU-treated OHCA experienced good neurological and functional outcome, living at home and being independent in basic ADL-functions. Less than 10% of the one-year survivors lived in long-term facilities, and only 3% of those OHCA patients who lived at home before the arrest needed long-term facility care one year later. This need was not based solely on the hypoxic-ischemic brain injury.

The high percentage of survivors that were independent in

Conclusion

In this national population based prospective cohort study including ICU-treated unconscious cardiac arrest patients of all etiologies, four of ten patients survived to one year. Nine of ten survivors were independent, lived at home, participated activities outside home, and valued their quality of life to be as good as that of age- and sex-matched general population.

Conflict of interest statement

The authors have no conflicts of interests to declare.

Acknowledgements

This study was supported, in part, by Helsinki University Central Hospital (EVO TYH 102010070) and by a grant from Stiftelsen Dorothea Olivia, Karl Walter och Jarl Walter Perkléns minne.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at https://doi.org/10.1016/j.resuscitation.2018.05.011.

    ☆☆

    Data from the prospective, nationwide FINNRESUSCI cohort.

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