Caregiver strain among relatives of out-of-hospital cardiac arrest survivors; the DANCAS relative survey.

BACKGROUND: Knowledge about caregiver strain among relatives of out-of-hospital cardiac arrest (OHCA) survivors is limited. Thus, the objectives were to i) describe differences in self-reported mental well-being, mental health, and caregiver strain at different time points (1-5 years) post-OHCA and ii) investigate characteristics associated with caregiver strain. METHODS: A national cross-sectional survey (DANCAS) from October 2020 to March 2021 with OHCA survivors and their closest relatives. The relative survey included the WHO-5 Well-being Index (WHO-5), the Hospital Anxiety and Depression Scale (HADS) and the Modified Caregiver Strain Index (M-CSI). Differences in scores between time groups were explored using descriptive statistics. Associations between characteristics and caregiver strain were investigated with multivariable logistic regression models, presented as odds ratios (OR) with 95% confidence intervals (CI), adjusted for gender, age, education status, relative affiliation, and time after OHCA. RESULTS: Of 561 relatives, 24% (n = 137) experienced caregiver strain, with no significant differences in the relatives' mental well-being, mental health, or caregiver strain with time since OHCA. In the adjusted analyses, older age (OR 0.98 95% CI 0.96;0.99) and several self-reported outcomes, including reduced mental well-being (WHO-5 OR 7.27 95% CI 4.86;11.52), symptoms of anxiety (HADS-A OR 6.01 95% CI 3.89;9.29) and depression (HADS-D OR 15.03 95% CI 7.33;30.80) were significantly associated with worse caregiver strain. CONCLUSION: Nearly one-quarter of relatives of OHCA survivors experience caregiver strain, with this proportion remaining unchanged with time. Several outcomes were associated with caregiver strain, emphasising the need to identify relatives at greater risk of burden following OHCA.

Associations between initial heart rhythm and self-reported health among cardiac arrest survivors - A nationwide registry study.

BACKGROUND: Non-shockable initial rhythm is a known risk factor for high mortality at cardiac arrest (CA). However, knowledge on its association with self-reported health in CA survivors is still incomplete. AIM: To examine the associations between initial rhythm and self-reported health in CA survivors. METHODS: This nationwide study used data from the Swedish Register for Cardiopulmonary Resuscitation 3-6 months post CA. Health status was measured using EQ-5D-5L and psychological distress by the Hospital Anxiety and Depression Scale (HADS). Kruskal-Wallis test was used to examine differences in self-reported health between groups of different initial rhythms. To control for potential confounders, age, sex, place of CA, aetiology, witnessed status, time to CPR, time to defibrillation, and neurological function were included as covariates in multiple regression analyses for continuous and categorical outcomes. RESULTS: The study included 1783 adult CA survivors. Overall, the CA survivors reported good health status and symptoms of anxiety or depression were uncommon (13.7% and 13.9% respectively). Survivors with PEA and asystole reported significantly more problems in all dimensions of health status (p = 0.037 to p < 0.001), anxiety (p = 0.034), and depression (p = 0.017) compared to VT/VF. Overall, these differences did not remain in the adjusted regression analyses. CONCLUSIONS: Initial rhythm is not associated with self-reported health when potential confounders are controlled. Initial rhythm seems to be an indicator of unfavourable factors causing the arrest, or factors related to characteristics and treatment. Therefore, initial rhythm may be used as a proxy for identifying patients at risk for poor outcomes such as worse health status and psychological distress.

Observer-reported cognitive decline in out-of-hospital cardiac arrest survivors and its association with long-term survivor and relative outcomes.

AIM: Long-term cognitive decline after out-of-hospital cardiac arrest (OHCA) is still poorly understood. This study describes long-term observer-reported cognitive decline among Danish OHCA survivors, including differences in years since the event, and investigates characteristics and self-reported outcomes associated with observer-reported cognitive decline. METHODS: Adults who survived an OHCA from 2016 to 2019, and their relatives, completed the national DANish Cardiac Arrest Survivorship survey. Relatives completed the Informant Questionnaire on Cognitive Decline in the Elderly, Cardiac Arrest version (IQCODE-CA), the Hospital Anxiety and Depression Scale (HADS) and the World Health Organisation-Five Well-being index; and survivors completed the Two Simple Questions (everyday activities and mental recovery), the Modified Fatigue Impact Scale, HADS, and the Short World Health Organisation Disability Assessment Schedule 2.0. Potential associations between survivor characteristics and the IQCODE-CA were investigated using a multivariable logistic regression model. Self-reported outcomes among survivors and relatives, and the association with IQCODE-CA scores were investigated using separate logistic regression models. RESULTS: Total median IQCODE-CA score was 3.04 (IQR: 3.00-3.27), with 47% having possible cognitive decline (score ≥ 3.04), consistent across time groups. Increasing age (OR 0.98, 95% CI: 0.97-0.99) and worse self-reported mental and physical outcomes for survivors and relatives, except 'everyday activities' were significantly associated with possible cognitive decline among survivors. CONCLUSIONS: Nearly half of OHCA survivors may suffer long-term cognitive decline. Worse self-reported mental and physical outcomes among survivors and their relatives are associated with potential cognitive decline emphasising the need for post-OHCA care to include systematic neurocognitive assessment, tailored support and effective rehabilitation.

Logistic and cognitive-emotional barriers experienced by first responders when alarmed to get dispatched to out-of-hospital cardiac arrest events: a region-wide survey.

Out-of-hospital cardiac arrest (OHCA) is a major public health concern with low survival rates. First responders (FRs) and public access defibrillation (PAD) programs can significantly improve survival, although barriers to response activation persist. The Emilia Romagna region in Italy has introduced a new system, the DAE RespondER App, to improve the efficiency of FR dispatch in response to OHCA. The study aimed to evaluate the association between different logistic factors, FRs' perceptions, and their decision to accept or decline dispatch to an OHCA scene using the DAE RespondER App. A cross-sectional web survey was conducted, querying 14,518 registered FRs using the DAE RespondER app in Emilia Romagna. The survey explored logistic and cognitive-emotional perceptions towards barriers in responding to OHCAs. Statistical analysis was conducted, with responses adjusted using non-response weights. 4,644 responses were obtained (32.0% response rate). Among these, 1,824 (39.3%) had received at least one dispatch request in the past year. Multivariable logistic regression showed that being male, having previous experience with OHCA situations, and having an automated external defibrillator (AED) available at the moment of the call were associated with a higher probability of accepting the dispatch. Regarding FRs' perceptions, logistic obstacles were associated with mission rejection, while higher scores in cognitive-emotional obstacles were associated with acceptance. The study suggests that both logistical and cognitive-emotional factors are associated with FRs' decision to accept a dispatch. Addressing these barriers and further refining the DAE RespondER App can enhance the effectiveness of PAD programs, potentially improving survival rates for OHCA. The insights from this study can guide the development of interventions to improve FR participation and enhance overall OHCA response systems.

Cognitive impairment and psychopathology in sudden out-of-hospital cardiac arrest survivors: Results from the REVIVAL cohort study.

AIM: To investigate cognitive impairment and psychopathology in out-of-hospital cardiac arrest (OHCA) survivors using a screening procedure during hospitalisation and examine the evolution of these parameters at three-month follow-up. METHODS: This multicentre cohort study screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA), for symptoms of anxiety, depression and traumatic distress using the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-revised (IES-R) during hospitalisation. At three-month follow-up, we evaluated cognitive impairment with a neuropsychological test battery and symptoms of psychopathology were re-assessed using HADS and IES-R. Logistic regression models were applied to examine associations between screening results and outcomes. RESULTS: This study included 297 OHCA survivors. During hospitalisation, 65% presented with cognitive impairment, 25% reported symptoms of anxiety, 20% symptoms of depression and 21% symptoms of traumatic distress. At follow-up, 53% reported cognitive impairment, 17% symptoms of anxiety, 15% symptoms of depression and 19% symptoms of traumatic distress. Cognitive impairment during hospitalisation was associated with higher odds (OR (95% CI) 2.55 (1.36-4.75), p = .02) of an unfavorable cognitive outcome at follow-up, and symptoms of psychopathology during hospitalisation were associated with higher odds of psychopathology at follow-up across all three symptom groups; anxiety (6.70 (2.40-18.72), p < .001), depression (4.69 (1.69-13.02), p < .001) and traumatic distress (7.07 (2.67-18.73), p < .001). CONCLUSION: OHCA survivors exhibited both cognitive impairment and symptoms of psychopathology during hospitalisation comparable to previous studies, which were associated with unfavorable mental health outcomes at three-month follow-up.

The prevalence of anxiety and depression in cardiac arrest survivors: A systematic review and meta-analysis.

OBJECTIVE: This systematic review aimed to identify the prevalence of anxiety and depression in cardiac arrest (CA) survivors. METHODS: A systematic review and network meta-analysis was performed on observational studies in adult cardiac arrest survivors with psychiatric disorders from PubMed, Embase, Cochrane Library and Web of Science. In the meta-analysis, we combined the prevalence quantitatively and analyzed the subgroup based on the classification indexes. RESULTS: We identified 32 articles that met the inclusion criteria. Regarding anxiety,the pooled prevalence was 24% (95% CI, 17-31%) and 22% (95% CI, 13-26%) in short-term and long-term respectively. The subgroup analysis showed that the pooled incidence in in-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrests (OHCA) survivors was 14.0% (95%CI, 9.0-20.0%) and 28.0% (95%CI, 20.0-36.0%) for short-term anxiety.The incidence of anxiety measured by, Hamilton Anxiety Rating Scale(HAM-A) and State-Trait Anxiety Inventory(STAI) was higher than other tools(P < 0.01). Regarding depression,the data analysis showed that the pooled incidence of short-term and long-term depression was 19% (95% CI, 13-26%) and 19% (95% CI, 16-25%), respectively. The subgroup analysis showed that the incidence of short-term and long-term depression was 8% (95% CI, 1-19%) and 30% (95% CI, 5-64%) for IHCA survivors, and was 18% (95% CI, 11-26%) and 17% (95% CI, 11-25%) for OHCA survivors. The incidence of depression measured by Hamilton Depression Rating Scale(HDRS) and Symptom check list-90(SCL-90) was higher than other assessment tools(P < 0.01). CONCLUSIONS: The meta-analysis indicated a high prevalence of anxiety and depression in CA survivors, and those symptoms persisted 1 year or more after CA. Evaluation tool is an important factor affecting the measurement results.

Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review.

OBJECTIVE: With a growing number of out-of-hospital cardiac arrest (OHCA) survivors globally, the focus of OHCA management has now broadened to survivorship. An outcome central to survivorship is health-related quality of life (HRQoL). This systematic review aimed to synthesise evidence related to the determinants of HRQoL of OHCA survivors. METHODS: We systematically searched MEDLINE, Embase, and Scopus from inception to 15 August 2022 to identify studies investigating the association of at least one determinant and HRQoL in adult OHCA survivors. All articles were independently reviewed by two investigators. We abstracted data pertaining to determinants and classified them using a well-established HRQoL theoretical framework - the Wilson and Cleary (revised) model. RESULTS: 31 articles assessing a total of 35 determinants were included. Determinants were classified into the five domains in the HRQoL model. 26 studies assessed determinants related to individual characteristics (n = 3), 12 studied biological function (n = 7), nine studied symptoms (n = 3), 16 studied functioning (n = 5), and 35 studied characteristics of the environment (n = 17). In studies that included multivariable analyses, most reported that individual characteristics (older age, female sex), symptoms (anxiety, depression), and functioning (impaired neurocognitive function) were significantly associated with poorer HRQoL. CONCLUSIONS: Individual characteristics, symptoms, and functioning played significant roles in explaining the variability in HRQoL. Significant non-modifiable determinants such as age and sex could be used to identify populations at risk of poorer HRQoL, while significant modifiable determinants such as psychological health and neurocognitive functioning could serve as targets for post-discharge screening and rehabilitation plans. PROSPERO registration number: CRD42022359303.

The living experience of surviving out-of-hospital cardiac arrest and spiritual meaning making.

AIM: To understand the meaning of surviving out of hospital cardiac arrest and its aftereffects among Greek-speaking survivors. DESIGN: Hermeneutical phenomenological method based on Martin Heidegger's philosophy. METHODS: Eight Greek-speaking out of hospital cardiac arrest survivors were recruited using purposive sampling method. Data collection and analysis using the seven stages of hermeneutic analysis described by Diekelman. Data were collected through semi-structured personal interviews with open-ended questions. RESULTS: Analysis revealed five themes: 'The unexpected attack', 'Experiencing a different world: Transformation of Body, Time, Emotion and Sensation', 'Restoration of the re-embodied self', 'Life transformation' and 'Personal transformation'. The themes are commensurate with transcultural components of Near-Death Experiences. Surviving out of hospital cardiac arrest was perceived as a 'divine gift' and a chance to continue 'living in a more conscious and meaningful way'. Despite participants' physical and psychosocial challenges, the narratives highlighted a newly acquired deep appreciation for the joy of life, living and others. Construction of meaning and a heightened spirituality seem central in reconstructing life after out of hospital cardiac arrest survivors. PATIENT OR PUBLIC CONTRIBUTION: Out of hospital cardiac arrest survivors reflected and described in-depth on their lived experiences of out of hospital cardiac arrest through a 60- to 90-min interview. In addition, the participants provided their feedback on the interpretation of the findings, confirmed the study findings, and ensured that the analysis reflected aspects of their individual experiences and were true to them.

With Fearful Eyes: Exploring Relatives' Experiences With Out-of-Hospital Cardiac Arrest: A Qualitative Study.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) imposes significant consequences for a family, but little is known about relatives' experiences. OBJECTIVE: Our aim was to explore relatives' experiences with the OHCA and the following months after. METHOD: A qualitative approach using phenomenological-hermeneutic methodology was applied. Data consisted of semistructured interviews with 12 relatives of OHCA survivors. We analyzed data based on Paul Ricoeur's theory of interpretation. RESULTS: Relatives experienced OHCA as an abrupt and stressful event filled with imposing concerns for the cardiac arrest survivor. Relatives were fellow sufferers confronted with the possibility of bereavement, watching from the sideline with fearful eyes. After the OHCA, relatives experienced a troubled time with anxiety and edginess, monitoring the survivor for signs of a new cardiac arrest and trying to adapt to a new normality. Relatives' previous identities and positions within their families were disrupted. CONCLUSION: Relatives were challenged with the OHCA and the trajectory after it, experiencing a high level of distress and anxiety. Relatives took on an immense responsibility, always watching the survivor for potential symptoms of a new cardiac arrest. The cardiac arrest and the survivor's possible cognitive impairments gave rise to assuming a new authority as a relative. We advocate for a new family approach to relatives, acknowledging relatives' stress and central role in supporting cardiac arrest survivors.

Relationships between serum levels of lactate dehydrogenase and neurological outcomes of patients who underwent targeted temperature management after out-of-hospital cardiac arrest.

ABSTRACT: This study aimed to evaluate times for measuring serum lactate dehydrogenase levels (SLLs) to predict neurological prognosis among out-of-hospital cardiac arrest (OHCA) survivors.This retrospective study examined patients who experienced OHCA treated with targeted temperature management (TTM). The SLLs were evaluated at the return of spontaneous circulation (ROSC) and at 24, 48, and 72 hours later. Neurological outcomes after 3 months were evaluated for relationships with the SLL measurement times.A total of 95 comatose patients with OHCA were treated using TTM. Seventy three patients were considered eligible, including 31 patients (42%) who experienced good neurological outcomes. There were significant differences between the good and poor outcome groups at most time points (P < .001), except for ROSC (P = .06). The ROSC measurement had a lower area under the receiver operating characteristic curve (AUC: 0.631, 95% confidence interval [CI]: 0.502-0.761) than at 48 hours (AUC: 0.830, 95% CI: 0.736-0.924), at 24 hours (AUC: 0.786, 95% CI: 0.681-0.892), and at 72 hours (AUC: 0.821, 95% CI: 0.724-0.919).A higher SLL seemingly predicted poor neurological outcomes, with good prognostic values at 48 hours and 72 hours. Prospective studies should be conducted to confirm these results.

Sulpiride intoxication: Case report of a rare intoxication.

Intoxications with sulpiride, an antipsychotic, are rare, and only limited literature is available. We describe a successful treatment of a sulpiride intoxication. A 67-year-old female, with a history of intentional suicide attempt, was admitted to the emergency department (ED) because of a suspected out-of-hospital cardiac arrest. At presentation, she was haemodynamically unstable, with a Glasgow Coma Scale of 3 and slight prolongation of QTc time. History taken from her husband raised suspicion of a suicide attempt with medication. Consultation of the on-call pharmacist and performance of a toxicology screening accelerated the diagnosis of a sulpiride intoxication. The patient was intubated because of respiratory insufficiency, admitted to the Intensive Care Unit (ICU) and treated with activated charcoal, laxatives and sodium bicarbonate. The following day, she was extubated with stable haemodynamics and a normalized ECG. Treatment of sulpiride intoxications is mainly symptomatic and consists of supportive care. An important note is the avoidance of antiarrhythmic drugs, except for lidocaine, epinephrine and dopamine, as they might worsen arrhythmia and hypotension.

Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2).

BACKGROUND: This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. METHODS: This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. DISCUSSION: In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03543371 . Registered 1 June 2018.

Out-of-hospital cardiac arrest quality of life follow-up study of survivors in Munster, Ireland.

Quality of life of out-of-hospital cardiac arrest (OHCA) survivors is believed to be as important as a factor in resuscitation outcome as the survival rate. The aim of this investigation is to assess the quality of life outcomes of survivors of out-of- hospital cardiac arrest in the Munster region. OHCAR was used to identify survivors who were contacted in writing to invite their participation. Internationally standardized phone based questionnaires were utilized to assess quality of life. The mean age of participants was 63.5 years with 85% male and 15% female. Eighty percent (n = 16) had no issues with mobility, 90% (n = 18) had no issues with personal care, 90% could undertake all usual activities, and 90% (n = 18) experienced no anxiety or depression. In conclusion, survivors of OHCA in the Munster area, who participated in this study, survive at a very high functional level.

Surviving out-of-hospital cardiac arrest: The important role of bystander interventions.

BACKGROUND: Substantial variations exist in relation to the characteristics and outcomes of out-of-hospital cardiac arrest (OHCA). As such, an understanding of region-specific factors is essential for informing strategies to improve OHCA survival. METHODS: Analysis of a large state-wide OHCA database of the Queensland Ambulance Service, Australia. Adult patients, attended by paramedics between January 2000 and December 2018 for OHCA of medical origin, where the arrest was not witnessed by paramedics, and resuscitation was attempted, were included. Factors associated with survival were investigated. The number needed to treat (NNT) for bystander interventions was estimated. RESULTS: Across a total of 23,510 patients, event survival, survival to discharge and 30-day survival was 22.6%, 11.9% and 11.5%, respectively. The corresponding figures for the Utstein patient group (initial shockable rhythm, bystander-witnessed) were 38.9%, 27.2% and 26.3%, respectively. Bystander cardiopulmonary resuscitation (CPR) and defibrillation substantially improved the likelihood of survival. The NNT for bystander CPR was 41, 63 and 64 for event survival, survival to discharge, and 30-day survival, respectively. The NNT for bystander defibrillation for these survival outcomes was 10, 14 and 14, respectively. CONCLUSIONS: Bystander interventions are critical for OHCA survival. Effort should be invested in strategies to improve the uptake of these interventions.

Evaluation of tools to assess psychological distress: how to measure psychological stress reactions in citizen responders- a systematic review.

BACKGROUND: Dispatched citizen responders are increasingly involved in out-of-hospital cardiac arrest (OHCA) resuscitation which can lead to severe stress. It is unknown which psychological assessment tools are most appropriate to evaluate psychological distress in this population. The aim of this systematic review was to identify and evaluate existing assessment tools used to measure psychological distress with emphasis on citizen responders who attempted resuscitation. METHODS: A systematic literature search conducted by two reviewers was carried out in March 2018 and revised in July 2018. Four databases were searched: PubMed, PsycInfo, Scopus, and The Social Sciences Citation Index. A total of 504 studies examining assessment tools to measure psychological distress reactions after acute traumatic events were identified, and 9 fulfilled the inclusion criteria for further analysis. The selected studies were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network. RESULTS: The Impact of Event Scale (IES) and The Impact of Event Scale-Revised (IES-R) were the preferred assessment tools, and were used on diverse populations exposed to various traumatic events. One study included lay rescuers performing bystander cardiopulmonary resuscitation and this study used the IES. The IES and the IES-R also have proven a high validity in various other populations. The Clinical administered PTSD scale (CAPS) was applied in two studies. Though the CAPS is comparable to both the IES-R and the IES, the CAPS assess PTSD symptoms in general and not in relation to a specific experienced event, which makes the scale less suitable when measuring stress due to a specific resuscitation attempt. CONCLUSIONS: The IES and the IES-R seem to be solid measures for psychological distress among people experiencing an acute psychological traumatic event. However, only one study has assessed psychological distress among citizen responders in OHCA for which the IES-R scale was used, and therefore, further research on this topic is warranted.

Willingness and obstacles of healthcare professionals to perform bystander cardiopulmonary resuscitation in China.

BACKGROUND: Bystander CPR (B-CPR) is crucial to increase survival of out-of-hospital cardiac arrest (OHCA), and this study is performed to assess the willingness and obstacles of Chinese healthcare professionals (HCPs) to perform B-CPR on strangers, as well as the factors associated with the willingness. METHODS: An internet-based questionnaire surveying demographic information, CPR training, CPR knowledge, willingness, and obstacles to perform B-CPR among 10,393 HCPs. A multivariate logistic regression analysis was used to evaluate the factors associated with the willingness. RESULTS: Here, 73.9% of HCPs were willing to perform B-CPR on strangers in China. The factors associated with the willingness were as follows: female, senior, working in Third-class hospitals, working in Pre-hospital emergency and Cardiology or Cardiac surgery, receiving current training, having adequate CPR knowledge. The main obstacles were fear of infection via mouth-to-mouth ventilations (MMV), fear of being blackmailed and fear of legal liability. CONCLUSION: About three quarters of HCPs are willing to perform B-CPR. Female HCPs, those who have more CPR experience, adequate knowledge, and recent training are more likely to perform B-CPR. Reform of the legal and credit system are needed, and recommendation of hands-only CPR is a possibility to encourage HCPs to perform B-CPR on strangers.

One-year longitudinal study of psychological distress and self-assessed health in survivors of out-of-hospital cardiac arrest.

OBJECTIVES: Few studies have investigated the psychological and health-related outcome after out-of-hospital cardiac arrest (OHCA) over time. This longitudinal study aims to evaluate psychological distress in terms of anxiety and depression, self-assessed health and predictors of these outcomes in survivors of OHCA, 3 and 12 months after resuscitation. METHODS: Recruitment took place from 2008 to 2011 and survivors of OHCA were identified through the national Swedish Cardiopulmonary Resuscitation Registry. Inclusion criteria were age ≥18 years, survival ≥12 months and a Cerebral Performance Category score ≤2. Questionnaires containing the Hospital Anxiety and Depression Scale and European Quality of Life 5 Dimensions 3 Level (EQ-5D-3L) were administered at 3 and 12 months after the OHCA. Participants were also asked to report treatment-requiring comorbidities. RESULTS: Of 298 survivors, 85 (29%) were eligible for this study and 74 (25%) responded. Clinically relevant anxiety was reported by 22 survivors at 3 months and by 17 at 12 months, while clinical depression was reported by 10 at 3 months and 4 at 12 months. The mean EQ-5D-3L index value increased from 0.82 (±0.26) to 0.88 (±0.15) over time. There were significantly less symptoms of psychological distress (p=0.01) and better self-assessed health (p=0.003) at 12 months. Treatment-requiring comorbidity predicted anxiety (OR 4.07, p=0.04), while being female and young age predicted poor health (OR 6.33, p=0.04; OR 0.91, p=0.002) at 3 months. At 12 months, being female was linked to anxiety (OR 9.23, p=0.01) and depression (OR 14.78, p=0.002), while young age predicted poor health (OR 0.93, p=0.003). CONCLUSION: The level of psychological distress and self-assessed health improves among survivors of OHCA between 3 and 12 months after resuscitation. Higher levels of psychological distress can be expected among female survivors and those with comorbidity, while survivors of young age and who are female are at greater risk of poor health.

Meta-analysis of the accuracy of termination of resuscitation rules for out-of-hospital cardiac arrest.

BACKGROUND: Our objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA). METHODS: We performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R. RESULTS: We identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%). CONCLUSIONS: The BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.