One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital

Abstract

Objective:To describe neurological status and associated factors of survivors after cardiac arrest, upon discharge, and at 6 and 12 month follow-up.Methods:A cohort, prospective, descriptive study conducted in an emergency room. Patients who suffered cardiac arrest and survived were included. A one-year consecutive sample, comprising 285 patients and survivors (n=16) followed up for one year after discharge. Neurological status was assessed by the Cerebral Performance Category before the cardiac arrest, upon discharge, and at 6 and 12 months after discharge. The following factors were investigated: comorbidities, presence of consciousness upon admission, previous cardiac arrest, witnessed cardiac arrest, location, cause and initial rhythm of cardiac arrest, number of cardiac arrests, interval between collapse and start of cardiopulmonary resuscitation, and between collapse and end of cardiopulmonary resuscitation, and duration of cardiopulmonary resuscitation.Results:Of the patients treated, 4.5% (n=13) survived after 6 and 12 months follow-up. Upon discharge, 50% of patients remained with previous Cerebral Performance Category of the cardiac arrest and 50% had worsening of Cerebral Performance Category. After 6 months, 53.8% remained in the same Cerebral Performance Category and 46.2% improved as compared to discharge. After 12 months, all patients remained in the same Cerebral Performance Category of the previous 6 months. There was no statistically significant association between neurological outcome during follow-up and the variables assessed.Conclusion:There was neurological worsening at discharge but improvement or stabilization in the course of a year. There was no association between Cerebral Performance Category and the variables assessed.

How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review

“… Reynolds et al, 2013 [ 24 ] Duration of resuscitation effors and functional outcome after out-of-hospital cardiac arrest when should we change to novel therapies? USA to estimate the dynamic probability of survival and functional recovery as a function of resuscitation effort duration to identify when to use novel therapies Cohort study Hospital CA database (Utstein-style template) 1014 Mean 65.2 57.7 Incl: 2005–2011; adults (≥18 yrs) Non-traumatic OHCA USA, single site, ED Functional status at discharge measured by mRS Shorter duration of CPR is independantly associated with survival to d/c with a favourable outcome (mRs of 0–3) Vancini-Campanharo et al, 2015 [ 25 ] One-year follow-up of neurological status of patients after cardiac arrest seen at the emergency room of a teaching hospital Brazil to describe neurological status and associated factors of survivors after CA, upon discharge and at six and twelve month follow ups Cohort study Utstein-style recording of consecutive IHCAs Neurological status evaluated with patient, family or guardian 16 not stated not stated Incl: 2011–2012; adults (≥17 yrs); resuscitated in ED; survivors to discharge OHCA Brazil, single site, city hospital ED Neurological status at discharge, 1, 6 and 12 months measured by CPC score No significant link between duration of CPR and neurological outcome Xue et al, 2013 [ 26 ] Factors influencing outcomes after cardiopulmonary resuscitation in the emergency department China to assess the factors influencing outcome of CPR in ED Cohort study Hospital registry Utstein-style template 725 46.94 ± 19.05 71.6 Incl: 2005–2011; adults (≥16 yrs) Excl: DNAR; incomplete data IHCA and OHCA China, single site, city hospital ED Neurologically favourable survival to discharge measured by CPC score CPR ≤15mins had significantly higher percentage of survivors with a neurologically favourable outcome Abbreviations: CA cardiac arrest, CPC cerebral performance category, CPR cardiopulmonary resuscitation, d/c discharge, ED emergency department, GWTG-R get with the guidelines-resuscitation, ICD implantable cardioverter defibrillator, ICU intensive care unit, IHCA ...…”

Brain Performance Evaluation Of Patients Survivors After A Cardiorespiratory Arrest

“…After six months of follow-up, 53.8% of patients remained with the same CPC and 46.2% improved the CPC about their score at discharge. After a year of follow-up, all patients remained with the same CPC in the previous six months [8].…”

“…This research followed the recommendations of Resolution Nº 466 of 12 December 2012, of the National Health Council [8], and authorized by the Ethics Committee in Research of the Federal University of Mato Grosso do Sul, adopted on November 2, 2014, under opinion Nº 856,096.…”

“…Thus, a study evaluating the neurological condition of patients after CPA can contribute to the development of prognostic strategies for these patients and consequently reduce patient treatment costs [8]. Given the above and considering the relevance of the topic presented, this study aimed to evaluate the brain performance of adult patients surviving a CPA before it, at discharge and after six months, and to describe the survival of patients six months after the hospital discharge.…”

Results of the implementation of integrated care after cardiorespiratory arrest in a university hospital

“…In Brazil, circulatory diseases, including cardiorespiratory arrest (CRA), were the main cause of death in 2011 1 . A total of 200,000 CRA events are estimated to occur every year, with approximately half occurring in hospital settings 2 .…”