Clinical paperSurviving out-of-hospital cardiac arrest: The neurological and functional outcome and health-related quality of life one year later☆,☆☆
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.
References (33)
- et al.
Good outcome in every fourth resuscitation attempt is achievable--an Utstein template report from the Stavanger region
Resuscitation
(2011) - et al.
Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest
Resuscitation
(2009) - et al.
Long-term neurological outcome after cardiac arrest and therapeutic hypothermia
Resuscitation
(2009) - et al.
Cardiac arrest and hypothermia treatment--function and life satisfaction among survivors in the first 6 months
Resuscitation
(2014) - et al.
Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival
Resuscitation
(2011) - et al.
Anxiety and depression among out-of-hospital cardiac arrest survivors
Resuscitation
(2015) - et al.
The influence of comorbidity on survival and long-term outcomes after out-of-hospital cardiac arrest
Resuscitation
(2017) - et al.
Cognitive problems in patients in a cardiac rehabilitation program after an out-of-hospital cardiac arrest
Resuscitation
(2015) - et al.
Conceptualizing and measuring health-related quality of life in critical care
J Crit Care
(2016) - et al.
Comparison of health-related quality of life and functional recovery measurement tools in out-of-hospital cardiac arrest survivors
Resuscitation
(2016)
Assessing health-related quality of life (HRQoL) in survivors of out-of-hospital cardiac arrest: a systematic review of patient-reported outcome measures
Resuscitation
Association of national initiatives to improve cardiac arrest management with rates of bystander intervention and patient survival after out-of-hospital cardiac arrest
JAMA
Improved survival after out-of-hospital cardiac arrest is associated with an increase in proportion of emergency crew--witnessed cases and bystander cardiopulmonary resuscitation
Circulation
Continuous improvements in “chain of survival” increased survival after out-of-hospital cardiac arrests: a large-scale population-based study
Circulation
Nationwide improvements in survival from out-of-hospital cardiac arrest in Japan
Circulation
cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest
Circulation
Cited by (27)
Mid-term (30- to 90-day) neurological changes in out-of-hospital cardiac arrest patients: A nationwide retrospective study (the JAAM-OHCA registry)
2022, American Journal of Emergency MedicineLong-term outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis
2022, ResuscitationCitation Excerpt :6 articles reported the HRQoL outcomes of OHCA patients. Four studies were comparative studies,40,59,69,95 which compared the HRQoL of the long-term survivors of OHCA to the general population, while two studies were non-comparative.67,75 Four instruments were used in the studies; the Mood and Feelings Questionnaire (MFQ), the Short-Form 36-item Health Survey (SF-36) and the Short-Form 12-item version (SF-12), and the EuroQol EQ-5D.
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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.
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Data from the prospective, nationwide FINNRESUSCI cohort.