Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest

Chocron, Richard; Fahrenbruch, Carol; Yin, Lihua; Guan, Sally; Drucker, Christopher; Shin, Jenny; Eisenberg, Mickey S.; Chatterjee, Neal A.; Kudenchuk, Peter J.; Rea, Thomas D.

doi:10.1016/j.resuscitation.2021.04.031

Cited by 11 publications

(20 citation statements)

References 16 publications

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“…6 Still, data suggest that patients with unfavorable neurologic outcomes represent only a small proportion of longterm survivors, as 2 large, long-term cohorts with a total of 1858 patients have shown that patients with an unfavorable neurologic outcome (cerebral performance category 3-4) account for only approximately 15% of patients with OHCA discharged alive. 23,25 Of the latter, only approximately 33% survive to 5 years of follow-up. 23,25 The good long-term survival as shown in this meta-analysis, combined with the probabil-ity of a good neurologic outcome, contributes to the evidence used in the decision-making process and discussion with patients and their relatives in the critical care setting and rehabilitation as well as the discussion in do not attempt resuscitation orders.…”

Section: Discussionmentioning

confidence: 99%

“…Studies used for the KM-based meta-analysis had different starting points regarding long-term follow-up. For the main analysis, the initial in-hospital mortality was excluded, and 10 studies 23,37,38,41,43,44,46,51,52,54 starting at hospital discharge and 4 studies 11,39,42,45…”

Section: Km-based Meta-analysismentioning

confidence: 99%

“…1,14 Of importance, previous studies [15][16][17][18][19] have concluded that patients who survive the initial OHCA often also have a favorable neurologic outcome. Several prognostic factors for long-term survival have been identified, including younger age, 20 receipt of bystander cardiopulmonary resuscitation, 21 absence of diastolic dysfunction, 22 functional status at hospital discharge, [23][24][25] initial cardiac arrest rhythm, 11 and post-cardiac arrest care at a tertiary referral hospital. 26 Still, although there is considerable research examining 1-year survival rates, 1,9,14 larger-scale studies of survival beyond 1 year are lacking.…”

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confidence: 99%

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Long-term Survival After Out-of-Hospital Cardiac Arrest

et al. 2022

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IMPORTANCE Data on long-term survival beyond 12 months after out-of-hospital cardiac arrest (OHCA) of a presumed cardiac cause are scarce.OBJECTIVE To investigate the long-term survival of adult patients after surviving the initial hospital stay for an OHCA.DATA SOURCES A systematic search of the EMBASE and MEDLINE databases was performed from database inception to March 25, 2021.STUDY SELECTION Clinical studies reporting long-term survival after OHCA were selected based on predefined inclusion and exclusion criteria according to a preregistered study protocol.DATA EXTRACTION AND SYNTHESIS Patient data were reconstructed from Kaplan-Meier curves using an iterative algorithm and then pooled to generate survival curves. As a separate analysis, an aggregate data meta-analysis was performed. MAIN OUTCOMES AND MEASURESThe primary outcome was long-term survival (>12 months) after OHCA for patients surviving to hospital discharge or 30 days after OHCA. RESULTSThe search identified 15 347 reports, of which 21 studies (11 800 patients) were included in the Kaplan-Meier-based meta-analysis and 33 studies (16 933 patients) in an aggregate data meta-analysis. In the Kaplan-Meier-based analysis, the median survival time for patients surviving to hospital discharge was 5.0 years (IQR, 2.3-7.9 years). The estimated survival rates were 82.8% (95% CI, 81.9%-83.7%) at 3 years, 77.0% (95% CI, 75.9%-78.0%) at 5 years, 63.9% (95% CI, 62.3%-65.4%) at 10 years, and 57.5% (95% CI, 54.8%-60.1%) at 15 years. Compared with patients with a nonshockable initial rhythm, patients with a shockable rhythm had a lower risk of long-term mortality (hazard ratio, 0.30; 95% CI, 0.23-0.39; P < .001). Different analyses, including an aggregate data meta-analysis, confirmed these results. CONCLUSIONS AND RELEVANCEIn this comprehensive systematic review and meta-analysis, long-term survival after 10 years in patients surviving the initial hospital stay after OHCA was between 62% and 64%. Additional research is needed to understand and improve the long-term survival in this vulnerable patient population.

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Section: Discussionmentioning

confidence: 99%

Section: Km-based Meta-analysismentioning

confidence: 99%

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Long-term Survival After Out-of-Hospital Cardiac Arrest

et al. 2022

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“…Second, CPC scores at ICU discharge were retrospectively determined based on information gathered from patient charts. Although this may introduce some bias, similar methodology has been used by Chocron et al [ 23 ]. Also, at ICU discharge patients can still neurologically improve or deteriorate; therefore, the CPC score at the time of ICU discharge can be an over- or underestimation of the long-term neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes with Targeted Temperature Management (TTM) in Comatose Out-of-Hospital Cardiac Arrest Patients—A Retrospective Cohort Study

Scholte

Wees

Rietdijk

et al. 2022

JCM

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Purpose: we evaluated the effects of the shift of a targeted temperature management (TTM) strategy from 33 °C to 36 °C in comatose out-of-hospital cardiac arrest (OHCA) patients admitted to the Intensive Care Unit (ICU). Methods: we performed a retrospective study of all comatose (GCS < 8) OHCA patients treated with TTM from 2010 to 2018 (n = 798) from a single-center academic hospital. We analyzed 90-day mortality, and neurological outcome (CPC score) at ICU discharge and ICU length of stay, as primary and secondary outcomes, respectively. Results: we included 798 OHCA patients (583 in the TTM33 group and 215 in the TTM36 group). We found no association between the TTM strategy (TTM33 and TTM36) and 90-day mortality (hazard ratio (HR)] 0.877, 95% CI 0.677–1.135, with TTM36 as reference). Also, no association was found between TTM strategy and favorable neurological outcome at ICU discharge (odds ratio (OR) 1.330, 95% CI 0.941–1.879). Patients in the TTM33 group had on average a longer ICU LOS (beta 1.180, 95% CI 0.222–2.138). Conclusion: no differences in clinical outcomes—both 90-day mortality and favorable neurological outcome at ICU discharge—were found between targeted temperature at 33 °C and 36 °C. These results may help to corroborate previous trial findings and assist in implementation of TTM.

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“…The probability of death specific to each CPC score for the first sub-period (from 3 months after discharge until 10 years) was derived from the literature that followed up OHCA patients for 10 years following the index event. 22 For the second sub-period (after 10 years), we assumed no excess mortality (i.e. OHCA had no effect on survival after 10 years), 14 and used age and sex-specific annual probability of death from the Australian Life Tables ( Supplementary Table S1 ).…”

Section: Methodsmentioning

confidence: 99%