Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy.

Nichol G, Guffey D, Stiell IG, Leroux B, Cheskes S, Idris A, Kudenchuk PJ, Macphee RS, Wittwer L, Rittenberger JC, Rea TD, Sheehan K, Rac VE, Raina K, Gorman K, Aufderheide T; Resuscitation Outcomes Consortium Investigators.


Abstract

IMPORTANCE:

Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA).

OBJECTIVE:

We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors.

DESIGN:

Prospective cohort sub-study of a randomized trial.

SETTING:

The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium.

PARTICIPANTS:

Consenting survivors to discharge.

MAIN OUTCOME MEASURES:

Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS).

RESULTS:

Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge.

CONCLUSIONS AND RELEVANCE:

The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.


http://www.ncbi.nlm.nih.gov/pubmed/26025570