Long-term survival after successful out-of-hospital resuscitation
Abstract
Between 1983 and 1989, 962 patients in Rotterdam were resuscitated outside hospital, of whom 240 (25%) could be discharged alive. A follow-up study was performed to determine prognosis in these patients. Of the 240 survivors of out-of-hospital resuscitation 80% survived after 1 year and 61% after 5 years. During the first year, 9% suffered from myocardial (re)infarction and 13% underwent coronary bypass surgery or angioplasty. Within the first 3 years after resuscitation 60% of the patients were readmitted to hospital. Permanent or temporary neurological deficits were observed in 30 patients (14%). Patients with a primary arrhythmia without myocardial infarction had a worse prognosis than patients with a cardiac arrest in the context of an infarct. Survival was better in patients in whom resuscitation was initiated by physicians or ambulance-nurses, than in patients resuscitated by lay-people. Multivariate analysis revealed that this difference could be explained by a larger proportion of patients with a primary arrhythmia in the latter group. Since long-term prognosis after out-of-hospital resuscitation is satisfactory, programmes for resuscitation courses should be stimulated. Such programmes should aim predominantly at relatives of patients with known heart disease, police officers and children.
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Cited by (32)
Recurrent out-of-hospital cardiac arrest
2017, ResuscitationCitation Excerpt :There is significant variability in the reported long-term outcomes of OHCA survivors which makes comparison of our findings with other reports difficult. For instance, the rate of long-term survival after OHCA varies from 43% to 81% at 5 years follow-up [3,9–15]. The causes of death in survivors of OHCA are also unclear.
Little is known about the burden of recurrent out-of-hospital cardiac arrest (OHCA) episodes in initial survivors of OHCA. We sought to investigate the frequency of recurrent OHCA, describe time-to-event trends, and establish baseline predictors of occurrence.
Between January 2000 and June 2015, we included consecutive OHCA survivors to hospital discharge from the Victorian Ambulance Cardiac Arrest Registry. Patient identifiers were used to match index and recurrent episodes of OHCA, and death records from a government database. Kaplan-Meier curves and a Cox proportional-hazards model were used to estimate the long-term risk of recurrent OHCA and identify index characteristics associated with their occurrence.
Among 3581 survivors, 214 (6.0%) experienced a recurrent OHCA over a median time-at-risk of 5.0 years (interquartile range [IQR]: 2.0, 8.1). The median age at recurrent OHCA was 69 years, 72.9% were male, and 92.0% of events were fatal. Fatal recurrent OHCA episodes accounted for more than one-quarter of all deaths at follow-up. The probability of recurrent OHCA at 1, 5, 10 and 15 years was 2.4% (95% CI: 2.0%, 3.0%), 6.0% (95% CI: 5.2%, 6.9%), 8.4% (95% CI: 7.3%, 9.8%), and 11.2% (95% CI: 9.1%, 13.8%), respectively. In the multivariable model, the following baseline predictors were significantly associated with recurrent OHCA: respiratory (HR 1.88, 95% CI: 1.02, 3.47; p = 0.045) or overdose/poisoning aetiology (HR 2.47, 95% CI: 1.08, 5.62; p = 0.03), diabetes (HR 1.92, 95% CI: 1.17, 3.14, p = 0.01), heart failure (HR 2.22, 95% CI: 1.28, 3.85; p = 0.005), and renal insufficiency (HR 2.43, 95% CI: 1.23, 4.82; p = 0.01). The risk of recurrent OHCA did not decline over the study period (per year increase: HR 0.97, 95% CI: 0.93, 1.01; p = 0.13).
Recurrent OHCA episodes occur frequently in OHCA survivors, and could account for as many as one-quarter of all deaths at follow-up. Index characteristics may help to identify at-risk patients.
Evaluation of the Outcome of Out-of-Hospital Cardiac Arrest Resuscitation Efforts in Denizli, Turkey
2008, Journal of Emergency MedicineCitation Excerpt :Therefore, in Denizli there is generally a delay in informing 112 Emergency Medical Services. There have been a considerable number of data on long-term survival rates after successful resuscitation from OHCA (36–38). Unfortunately, there have often been different patient selection factors in these reports, preventing the results from being comparable.
The objective of this study was to evaluate the outcomes and associated factors for short-term success and long-term survival rates of resuscitated non-traumatic out-of-hospital cardiac arrest (OHCAs) in Denizli, Turkey. All non-traumatic OHCA patients from the Emergency Departments of the Pamukkale University and City Hospitals between the dates of January 1, 2004 and March 1, 2005 were included in this study. A successful outcome was defined as the return of spontaneous circulation or breathing, or evidence of a palpable pulse or a measurable blood pressure. Information on post-resuscitation long-term survival up to 9 months also was obtained by telephone. A total of 222 adults experiencing OHCAs were resuscitated. The number of successful outcomes was 85 (38.3%); 25 (11.2%) were discharged alive; and 21 (9.4%) were alive at the 9-month follow-up. The predicted mean arrest time was 11.7 min (95% confidence interval 10.27–13.2). Type of transportation to the Emergency Department (ambulance, 32.1% vs. private vehicle, 44.5%; p = 0.057), place of arrest (home, 32.6% vs. other, 44.0%; p = 0.08), first rhythm at the scene (asystole, 22.9% vs. ventricular fibrillation-pulseless ventricular tachycardia, 48.0%, vs. pulseless electrical activity, 12.5%; p = 0.056), and advanced cardiac life support starting time (the first 8 min, 46.8% vs. later than 8 min, 32.0%; p = 0.025) had an effect on outcome. Intensive public education for diagnosis and appropriate reporting of OHCA, the importance of bystander cardiopulmonary resuscitation, and the use of automated external defibrillators have an impact on the potential to increase the number of survivors.
Survival after out-of-hospital cardiac arrests in Katowice (Poland): Outcome report according to the "utstein style"
2004, ResuscitationThe purpose of this study was to evaluate the outcome of out-of-hospital cardiac arrest (CA) and cardiopulmonary resuscitation (CPR) in the city of Katowice, Poland, during a period of 1 year prior to the planned reorganization of the national emergency system. Data were collected prospectively according to a modified Utstein style. To ensure accurate data collection, a special method of reporting resuscitation events with the use of a tape-recorder was introduced. Patients were followed for a 1-year period. Between 1 July 2001 and 30 June 2002, out-of-hospital cardiac arrest was confirmed in 1153 patients. Cardiopulmonary resuscitation was attempted in 188 patients. Cardiac arrest of presumed cardiac aetiology (147) was bystander witnessed in 105 (71%) cases and lay-bystander basic life support was performed in 35 (24%). In the group of bystander witnessed arrest ventricular fibrillation (VF) or tachycardia was documented in 59, asystole in 40 and other non-perfusing rhythms in six patients. Of 147 patients with cardiac aetiology, return of spontaneous circulation (ROSC) was achieved in 64 (44%) patients, 15 (10%) were discharged alive and 9 (6%) were alive 1 year later. Most of these patients had a good neurological outcome. Time to first defibrillatory shock was significantly shorter for survivors (median 7 min) compared to non-survivors (median 10 min). The most important resuscitation and patient characteristics associated with survival were VF as initial rhythm, arrest witnessed, and lay-bystander CPR.
O objectivo deste estudo foi avaliar o resultado da paragem cardı́aca pré-hospitalar (CA) e da reanimação cardio-pulmonar (CPR) na cidade de Katowice, Polónia, durante o perı́odo de um ano antes da planeada reorganização do sistema nacional de emergência. Os dados foram recolhidos prospectivamente de acordo com um modelo de Utstein modificado. Por forma a assegurar uma correcta colheita dos dados, foi introduzido um método especial de descrição dos acontecimentos da reanimação utilizando gravador de cassetes. Os doentes foram seguidos em follow-up durante 1 ano. De 1 de Julho de 2001 a 30 de Junho de 2002 foi confirmada paragem cardı́aca pré-hospitalar em 1153 doentes. Foi tentada reanimação cardio-pulmonar em 188 doentes. As paragens cardı́acas de etiologia cardı́aca provável (147) foram testemunhadas em 105 (71%) e a testemunha iniciou suporte básico de vida em 35 (10%) dos casos. Documentou-se fibrilhação ou taquicardia ventricular (VF) em 59, assistolia em 40 e outros ritmos sem perfusão em 6 doentes. Dos 147 doentes com etiologia cardı́aca, foi conseguido retorno de circulação espontânea (ROSC) em 64 (44%) doentes, 15 (10%) tiveram alta vivos e 9 (6%) estavam vivos ao fim de 1 ano. A maioria destes tinha um bom resultado neurológico. O tempo decorrido até ao primeiro choque de desfibrilhação foi significativamente menor para os sobreviventes (média de 7 min) em comparação com os falecidos (média de 10 min). As variáveis da reanimação e do doente, associadas à sobrevida, foram a VF como ritmo inicial, a paragem testemunhada e o inı́cio de CPR pela testemunha.
El propósito de este estudio fue evaluar el resultado del paro cardı́aco(CA) extrahospitalario y reanimación cardiopulmonar (CPR) en la ciudad de Katowice, Polonia, durante un perı́odo de un año, previo a la reorganización planificada del sistema de emergencias médicas. Se recogieron prospectivamente los datos de acuerdo a un estilo Utstein modificado. Para asegurar la recolección precisa de datos, se introdujo un método especial para reportar los eventos de resucitación usando una grabadora. Los pacientes fueron seguidos por un perı́odo de un año. Se confirmó paro cardı́aco extra hospitalario en 1153 pacientes entre Julio 1 de 2001 y el 30 de Junio 2002. Se intentó reanimación cardiopulmonar en 188 pacientes. 147 casos de paro cardı́aco de presunta etiologı́a cardı́aca fueron presenciados por testigos en 105 (71%) casos y se realizó soporte vital básico por testigo reanimador en 35 (24%). Se documentó fibrilación ventricular(VF) o taquicardia en 59, ası́stole en 40 y otros ritmos no perfusores en 6 pacientes. De 147 pacientes con etiologı́a cardı́aca, se alcanzó retorno a circulación espontánea (ROSC) en 64 (44%) pacientes, 15 (10%) fueron dados de alta vivos y 9 (6%) seguı́an con vida un año después. La mayorı́a de estos pacientes tuvo un buen resultado neurológico. El tiempo transcurrido hasta la primera descarga desfibriladora fue significativamente mas corto para los sobrevivientes (mediana 7 minutos) comparado con el de los no sobrevivientes(mediana 10 minutos). Las caracterı́sticas de resucitación y de paciente mas importantes asociadas con sobrevida fueron VF como ritmo inicial, paro presenciado, y CPR realizada por testigos.
Long term survival and costs per life year gained after out-of-hospital cardiac arrest
2004, ResuscitationPurpose: To study long-term survival and estimate the costs per year of survival after out-of-hospital cardiac arrest of cardiac origin. Materials and methods: Cardiac arrest patients treated by the physician-manned ambulance in Oslo from January 1971 to June 1992. The condition of the patient when discharged from hospital was noted and survival followed until June 2002. Costs of the Emergency Medical Service (EMS), hospital treatment, rehabilitation and nursing homes and psychiatric institutions after discharge from hospital were included in a cost-effectiveness analysis. Results: 1300 (42%) of 3065 patients receiving ALS were admitted to hospital after return of spontaneous circulation (ROSC). 1066 of these patients had a cardiac cause of the arrest, full hospital report and were found in the National Registry. Median age was 68 years (60–74) and 802 (75%) were men. 269 of the 1066 patients were discharged from hospital alive, 239 to their homes and 30 patients to rehabilitation/nursing homes or psychiatric institutions. The mean survival of the 1066 patients was 532 days. They spent mean 3.4 days in a CCU, 6.8 days in a general ward and 11.2 days in nursing/rehabilitation homes or psychiatric institutions. 30 patients were discharged to rehabilitation/nursing homes or psychiatric institutions. The mean survival time for the 269 patients discharged from hospital alive was 6.13 years. 110 patients were alive after five and 61 after 10 years. The cost per patient discharged alive was €40,642 or €6,632 per life year gained. Conclusions: Cardiac arrest patients do not occupy intensive care beds too long, and few end up in a vegetative state. Methodological differences in different studies makes meaningful comparisons of costs difficult, but the costs per life year saved are not high compared to other publications.
Objectivos: Estudar a sobrevida a longo prazo e o custo por ano de sobrevida depois de paragem cardı́aca de origem cardı́aca pré-hospitalar. Material e métodos: Doentes em paragem cardı́aca tratados por ambulâncias medicalizadas em Oslo de Janeiro de 1971 a Junho de 1992. Registou-se o estado do doente antes da alta hospitalar e seguiram-se os doentes até Junho de 2002. Na análise de custo-eficácia foram incluı́dos os custos do Serviço de Emergência Medicalizado (EMS), o tratamento no hospital e nos lares e centros de reabilitação, depois da alta hospitalar. Resultados: Foram hospitalizados depois do retorno da circulação espontânea (ROSC) 1300 (42%) dos 3065 doentes submetidos a suporte avançado de vida (ALS). Desses doentes 1066 tiveram paragem de causa cardı́aca, relatório médico hospitalar e eram identificáveis no registo nacional. A idade média era de 68 anos (60–74) e 802 (75%) eram homens. Dos 1066 doentes, 269 tiveram alta hospitalar vivos, 239 para o domicı́lio e para centros de enfermagem / reabilitação ou instituições psiquiátricas. A sobrevida média dos 1066 doentes foi de 532 dias. Estiveram em média 3,4 dias na CCU, 6,8 na enfermaria e 11,2 na instituição de enfermagem / reabilitação ou psiquiátrica. 30 desses doentes tiveram alta para instituições psiquiátricas. A sobrevida média dos que tiveram alta hospitalar vivos foi de 6,13 anos. Aos 6 anos havia 110 doentes vivos e aos 10 anos 61. O custo de cada doente com alta vivo foi de € 40 642 ou € 6 632 por ano de vida ganho. Conclusão: Os doentes com paragem cardı́aca não ocupam as camas de cuidados intensivos por longo tempo e são poucos os que persistem em estado vegetativo. As diferenças metodológicas entre diferentes estudos tornam difı́cil a comparação de resultados, contudo, os custos por ano de vida salvo não são altos quando comparados com os de outras publicações.
Propósito: Estudiar la sobrevida a largo plazo y estimar los costos por año de sobrevida después de un paro cardı́aco extrahospitalario de origen cardı́aco. Material y métodos: Pacientes de paro cardı́aco tratados por ambulancias tripuladas por médicos en Oslo, desde Enero 1971 hasta Junio 1992. La condición del paciente al alta fue registrada, y la sobrevida seguida hasta Junio de 2002. Se incluyeron en el análisis de costo-efectividad los costos del servicio de emergencias médicas (EMS), tratamiento hospitalario, centros de rehabilitación, casas de reposo e instituciones psiquiátricas después del alta hospitalaria. Resultados: 1300 (42%) de 3065 pacientes que recibieron soporte vital avanzado (ALS) fueron admitidos al hospital después de retorno a circulación espontánea (ROSC). 1066 de estos pacientes tenı́a paro de causa cardı́aca, historia hospitalaria completa y fueron encontrados en el Registro Nacional. La mediana de edad fue 68 años (60–74) y 802 (75%) eran varones.269 de esos 1066 pacientes fueron dados de alta vivos, 239 a sus hogares y 30 pacientes a hogares de rehabilitación, casas de reposo o instituciones psiquiátricas. El promedio de tiempo de sobrevida para los 269 pacientes vivos al alta fue de 6.13 años. 110 pacientes estaban vivos después de 5 años y 61 después de 10años. El costo por paciente vivo al alta fue de ϵ 40,642 ó ϵ 6,632 por año de vida ganado. Conclusiones: Los pacientes de paro cardı́aco no ocupan camas de cuidados intensivos por muchos dı́as, y pocos terminan en estados vegetativos. Las diferencias metodológicas en distintos estudios hacen difı́ciles comparaciones de costos importantes, pero el costo por año de vida salvado no es alto comparado con otras publicaciones.
Time trends in long-term mortality after out-of-hospital cardiac arrest, 1980 to 1998, and predictors for death
2003, American Heart JournalCitation Excerpt :Several papers have reported on age as an independent predictor of long-term mortality after cardiac arrest,27–31 and this study adds to that pile of evidence. We assumed that a history of heart failure31,32 and a diagnosis of acute myocardial infarction in connection with cardiac arrest31,33 would independently be predictive of long-term prognosis, but this was not the case. However, one might consider the prescription of digitalis at discharge as a weak surrogate for heart failure, and this prescription was more common during period 1 (ie, before the widespread use of ACE inhibitors in heart failure).
We studied time trends in long-term survival after out-of-hospital cardiac arrest (OHCA) for patient characteristics and described predictors for death after discharge. Because long-term prognosis among patients with coronary heart disease has improved in the last decades, we hypothesized that the prognosis after OHCA would improve with time.
We analyzed data that were prospectively collected from all patients discharged from the hospital after OHCA in the community of Göteborg, Sweden, from 1980 to 1998 and divided the data into 2 time periods, 1980 to 1991 and 1991 to1998, with an equal number of patients.
A total of 430 patients were included in the survey. Age, sex proportions, cardiovascular comorbidity, resuscitation factors, and inhospital complications did not change with time. A diagnosis of a precipitating myocardial infarction was more common during period 1 (66% vs 54%). The prescription of aspirin (22% vs 52%), angiotensin-converting enzyme inhibitors (7% vs 29%), anticoagulants (13% vs 27%), and lipid-lowering agents (0% vs 6%) at discharge increased during period 2. Long-term survival did not improve with time; the 5-year mortality rates were 53% in period 1 and 52% in period 2. Independent predictors of an increased risk of death included age (risk ratio [RR] 1.06, 95% CI 1.05–1.08), history of myocardial infarction (RR 2.02, 95% CI 1.51–2.72), history of smoking (RR 1.77, 95% CI 1.29–2.44), and worse cerebral performance at discharge (RR 1.71, 95% CI 1.44–2.02). The prescription of β-blockers at discharge was independently predictive of decreased risk of death (RR 0.63, 95% CI 0.46–0.85).
The long-term survival rate after OHCA did not change. Baseline characteristics remained generally unchanged, but the drugs prescribed at discharge changed in several aspects. Age, a history of myocardial infarction, a history of smoking, cerebral performance category at discharge, and the prescription of β-blockers were independent predictors of outcome.
The epidemiology of out-of-hospital 'sudden' cardiac arrest
2002, ResuscitationIt is difficult to assemble data from an out-of-hospital cardiac arrest since there is often lack of objective information. The true incidence of sudden cardiac death out-of-hospital is not known since far from all of these patients are attended by emergency medical services. The incidence of out-of-hospital cardiac arrest increases with age and is more common among men. Among patients who die, the probability of having a fatal event outside hospital decreases with age; i. e. younger patients tend to more often die unexpectedly and outside hospital. Among the different initial arrhythmias, ventricular fibrillation is the most common among patients with cardiac aetiology. The true distribution of initial arrhythmias is not known since several minutes most often elapse between collapse and rhythm assessment. Most patients with out-of-hospital cardiac arrest have a cardiac aetiology. Out-of-hospital cardiac arrests most frequently occur in the patient's home, but the prognosis is shown to be better when they occur in a public place. Witnessed arrest, ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, cardiac arrest in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and hospital treatment among patients with prehospital cardiac arrest.