Elsevier

Resuscitation

Volume 91, June 2015, Pages 99-103
Resuscitation

Clinical Paper
Life after cardiac arrest: A very long term follow up

https://doi.org/10.1016/j.resuscitation.2015.01.009Get rights and content

Abstract

Aim

To describe survival and causes of death after cardiac arrest (CA) and the life situation of very long term survivors.

Methods

Individuals with successful resuscitation treated at the Sahlgrenska university hospital during 1995–1999 and presented in former CA publications were studied. Survival time and causes of death data were extracted from the individuals who had died's records. Very long term survivors were offered a follow up visit at home. Mini Mental State Examination (MMSE) used to describe cognitive abilities and EQ-5D to assess quality of life. The life situation was also explored.

Results

14 out of 104 possible participants had survived to follow up. The median time to follow up among the 8 who agreed to participation was 17 years. Out of the 8 participants, 4 failed to reach the cut off score of normal cognitive abilities in the MMSE and 7/8 participants did not reach the cut off score for normal cognitive function in the MoCA.

Overall the participants were content with their life situation and QoL. However, a tendency towards lower scores on the cognitive testing and a lower self-reported QoL was observed. No depression, post-traumatic stress disorder or anxiety disorder were found.

Conclusions

A CA may lead to permanent cognitive impairments and the risk of dementia may be higher because of the injuries sustained during the collapse. However, further studies with more participants are needed to fully determine the risk of cognitive impairment after a CA. Regarding life situation, there was a tendency of lower QoL with lower scores on the cognitive testing. With a new treatment paradigm, there is a need for long term studies regarding this new population.

Introduction

Every year 275 000 people in Europe1 and approximately 10 000 in Sweden suffer a cardiac arrest (CA), about 20% of which take place inside a hospital.2 CA mortality is high, described in 2007 as, at one year after discharge to be 17% and 10 years after discharge to be 54–82%.3, 4 Often survival after CA is defined as being alive 30 days post CA. The current treatment of CA, the chain of survival5 is widespread and has a success rate of 10–28% in Sweden. The definition of success, in the studies on survival after CA in Sweden, was discharging a living patient. The prognosis of these patients mainly depends on where the CA occurs and it is more favourable if the CA takes place inside a hospital rather than out-of-hospital.2

Survivors can be stricken by co-morbidities. The sudden cessation of blood flow during a CA and the loss of pulse lead to brain damage due to global cerebral ischaemia.6 It has been shown that many patients still suffer from cognitive deficits two years7 and 8 years after CA.8 It has also been shown that one year post CA patients have reduced independency in Activities in Daily Living (ADL)9 and only a few return to work. On the other hand, it has also been shown that cognitive function and quality of life (QoL) can improve with time.9, 10

Among other things, higher public access to automatic defibrillators and an increasing public knowledge how to perform basic Cardio Pulmonary Resuscitation (CPR) have resulted in more people surviving their CA.11 This leads to a growing interest in the long-term effects of CA12 coping with life after it and in the disabilities and rehabilitation of survivors.

The overall aim of this study was to describe the survival and cause of death after CA and to analyse the living situation of those still alive a very long time after CA.

Section snippets

Participants

The participants for this study were extracted from studies following patients surviving an out-of-hospital cardiac arrest (OHCA) after successful resuscitation3, 9, 13 in 1995–99. In the original cohort 105 individuals were followed and the inclusion process of the participants is shown in Fig. 1.

Information on survival was gathered through medical charts and the population register and was analysed with regards to gender and age at CA. Date and cause of death were confirmed through the

Study population

Of the original 104 individuals with CA, 56 (53.8%) survived the first 30 days, 14 women and 42 men (CA survivors). Long term survival is presented in Fig. 2 for the men (data not shown for women due to small numbers) and for the whole group in Table 1. In contrast to the male survivors, the female survivors had a more evenly distributed survival rate until 18 years after CA when all women were deceased. However, when calculating the amount of days survived by the deceased at very long term

Discussion

The overall aim of this study was to describe the survival and cause of death after CA and the living situation of those still alive a very long time after CA. The findings of this study show that if you survive the critical first year after the arrest, the chance of living for a long time increases. Death in the CA group is dominated by cardio-vascular causes, which is in contrast to the general Swedish population where 38.5% of females and 37.5% of males die due to cardio-vascular diseases.22

Limitations

The medical system has changed during the last 17 years and the outcomes of individuals having a CA now may not be the same in 17 years time. One example of this is the Swedish guidelines24 now recommend of using hypothermia as a treatment to save cognitive function in an otherwise biological vital patient having a CA. This development of treatments and guidelines might implicate that the very long term effects of a CA suffered now might not be as distinct as in the very long term survivors of

Conclusion and implications

The conclusion is that the CA probably had an effect on the cognitive abilities of this study group even as long as 17 years after the collapse and this implicates that the risk of cognitive failure may be higher in this group of people compared to the population in general. However, further studies and an increased number of participants are needed to confirm this thesis.

With a new treatment paradigm, there is a need for long term studies regarding this new population.

Conflict of interest statement

The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Authors’ contribution

Anna-Eva Andersson, Hans Rosén, Katharina S. Sunnerhagen are responsible for drafting/revising the manuscript for content, design of the study concept. Anna-Eva Andersson in association with Katharina S. Sunnerhagen involved in interpretation of data. She is solely responsible for data acquisition and statistical analysis while Katharina S. Sunnerhagen is responsible for study supervision or coordination, obtaining funding.

Acknowledgment

The first author thank the research group at Rehabilitation medicine for input in the reading group.

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