Post-intensive care syndrome in out-of-hospital cardiac arrest patients: A prospective observational cohort study

Abstract

Introduction Intensive care unit patients are at risk for post-intensive care syndrome (PICS), which includes psychological, physical and/or cognitive sequelae after their hospital stay. Our aim was to investigate PICS in adult patients with out-of-hospital cardiac arrest (OHCA). Methods In this prospective observational cohort study, we assessed risks for PICS at 3 and 12-month follow-up within the following domains: a) physical impairment (EuroQol [EQ-5D-3L]), b) cognitive functioning (Cerebral Performance Category [CPC] score >1, modified Rankin Scale [mRS] >2) and c) psychological burden (Hospital Anxiety and Depression Scale [HADS], Impact of Event Scale-Revised [IES-R]). Results At 3 months, 69/139 patients (50%) met the definition of PICS including 37% in the physical domain, 25% in the cognitive domain and 13% in the psychological domain. Intubation (OR 2.3, 95%CI 1.1 to 5,0 p = 0.03), sedatives (OR 3.4, 95%CI 1 to 11, p = 0.045), mRS at discharge (OR 4.3, 95%CI 1.70 to 11.01, p = 0.002), CPC at discharge (OR 3.3, 95%CI 1.4 to 7.6, p = 0.005) and post-discharge work loss (OR 13.4, 95%CI 1.7 to 107.5, p = 0.014) were significantly associated with PICS. At 12 months, 52/110 (47%) patients had PICS, which was associated with prolonged duration of rehabilitation, higher APACHE scores, and higher mRS and CPC scores at hospital discharge. Conclusions Nearly half of long-term OHCA survivors show PICS after 3 and 12 months. These high numbers call for more emphasis on appropriate screening and treatment in this patient population. Future studies should evaluate whether early identification of these patients enables preventive strategies and treatment options.

Predictors of neurocognitive and psychological disorders in children after intensive care admission: A prospective cohort study

“… 24 Similarly, another study showed that eight patients still developed psychological distress at 12‐month follow‐up. 25 However, we also found that even though many of PICU survivors report an improvement in psychological distress at 3 months after PICU discharge, some subjects report worsened in psychological distress; hence, our results indicate that the psychological outcome after PICU discharge may differ considerably on an individual level. Therefore, screening for PICS during follow‐up of PICU discharge could help identify high‐risk patients who need psychological support.…”

“…In contrast, one study reported an improvement in levels of psychological distress after long‐term periods 24 . Similarly, another study showed that eight patients still developed psychological distress at 12‐month follow‐up 25 . However, we also found that even though many of PICU survivors report an improvement in psychological distress at 3 months after PICU discharge, some subjects report worsened in psychological distress; hence, our results indicate that the psychological outcome after PICU discharge may differ considerably on an individual level.…”

Post-intensive care syndrome and health-related quality of life in long-term survivors of cardiac arrest: a prospective cohort study

“…Sudden cardiac arrest is a leading global health issue, with survivors frequently experiencing physical, neurological, and psychological sequelae 1 – 4 . Approximately 18 to 35% of patients experiencing an in-hospital cardiac arrest (IHCA) survive to hospital discharge, whereas the survival rates for out-of-hospital cardiac arrest (OHCA) are substantially lower, with 9 to 10% surviving to hospital discharge 2 , 5 .…”

“…Multiple cohort studies have found evidence of high rates of PICS in ICU survivors. This is true for general intensive care unit (ICU) 9 patients and special populations such as treatment with extracorporeal membrane oxygenation, severe Coronavirus disease—2019 infections, acute respiratory distress syndrome, or subarachnoid hemorrhage 4 , 10 – 15 . PICS is an important driver of premature mortality and can have substantial financial implications for patients and their families 16 – 18 .…”

“…PICS is an important driver of premature mortality and can have substantial financial implications for patients and their families 16 – 18 . Physical, psychological, and cognitive long-term disabilities are well-known in cardiac arrest survivors 4 , 19 – 25 . In a previous study, our research group found evidence of PICS in 50% of survivors at 12 months of follow-up, with most impairments experienced in the physical domain 4 .…”