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

Abstract

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.

Comparison of different clinical risk scores to predict long-term survival and neurological outcome in adults after cardiac arrest: results from a prospective cohort study

“…Although substantial progress has been made in the prognostication of short-term outcomes after cardiac arrest [8,[11][12][13], prospective data for early prognostication of long-term outcomes (≥ 2 years) after cardiac arrest are scarce [14][15][16]. Recently, the focus in post-cardiac arrest research has shifted from short-term to longterm outcomes, as highlighted in the 2021 European guidelines for post-resuscitation care and two recently published systematic reviews and a meta-analysis [8,17,18]. Reliable prediction of long-term outcomes is of great importance because a change in the level of neurological functioning can still occur months after hospital discharge [8,13].…”

Comment on: Post‑resuscitation diastolic blood pressure is a prognostic factor for outcomes of cardiac arrest patients

“…It is surprising to not consider in the multivariate analysis no flow duration, which is one Utstein variable [ 2 ]. Moreover, the better outcome among patients with higher DBP may per se partly be explained by a greater representation of patients with initial shockable rhythm in this subgroup [ 3 ], and it would have been interesting to assess the potential interaction between these two variables.…”

Predicting neurological outcome in adult patients with cardiac arrest: systematic review and meta-analysis of prediction model performance

“…Cardiac arrest is a significant cause of premature death worldwide with high mortality and the risk of unfavourable neurological outcome due to hypoxic-ischaemic brain injury [ 1 – 5 ]. Intensive care unit (ICU) physicians frequently encounter severely ill cardiac arrest survivors in a state of persistent reduced consciousness and haemodynamic instability sometimes complicated by sedation and paralysis due to targeted temperature management.…”