Factors associated with return to work among survivors of out-of-hospital cardiac arrest.

BACKGROUND: Although out-of-hospital cardiac arrest (OHCA) is a major cause of global mortality, survival rates have increased over the last decade. As such, there is an increasing need to explore long-term functional outcomes of survivors, such as return to work (RTW). METHODOLOGY: We analysed baseline and 12-month follow-up data from the Victorian Ambulance Cardiac Arrest Registry for patients that arrested between 2010 and 2016 who were working prior to their arrest. We also conducted more detailed RTW interviews in a subset of OHCA survivors who arrested between July and September 2017. Factors associated with RTW were assessed using multivariable logistic regression analysis. RESULTS: A total of 884 previously working survivors were included in the analysis, 650 (73%) of whom RTW. Male sex (AOR 1.80; 95%CI: 1.10-2.94), arrests witnessed by emergency medical services (AOR 2.72; 95%CI: 1.50-9.25), discharge directly home from hospital (AOR 4.13; 95%CI: 2.38-7.18) and favourable 12-month health-related quality of life according to the EQ-5D were associated with RTW. Increasing age (AOR 0.97; 95%CI: 0.95-0.98), traumatic arrest aetiology (AOR 0.18; 95%CI: 0.04-0.77), and labour-intensive occupations (AOR 0.44; 95%CI: 0.29-0.66) were associated with decreased odds of RTW. Of the 23 OHCA survivors that participated in the more detailed RTW telephone-interview, 87% RTW. Flexible work hours or modified duties were offered to 74% of participants. Fatigue was the most frequently reported barrier to RTW. CONCLUSION: This is the largest study to collectively examine factors associated with RTW among survivors of OHCA. Although larger qualitative studies are needed, our findings highlight which patients are at risk of not RTW and who may benefit from targeted rehabilitation strategies.

Out-of-hospital cardiac arrest survivors need both cardiological and neurological rehabilitation!

PURPOSE OF REVIEW: Most survivors of out-of-hospital cardiac arrest (OHCA) suffer from cardiologic symptoms and approximately half of them experience cognitive problems because of hypoxic brain damage. Symptoms of anxiety and depression are also common. This review aims to give an overview of recent literature on rehabilitation treatment aiming at improvement of quality of life after OHCA. RECENT FINDINGS: Existing cognitive screening tools are now validated for OHCA survivors. OHCA patients with cognitive deficits may have lower exercise capacity. Cardiac rehabilitation seems to be well tolerated for OHCA survivors, with outcomes comparable to myocardial infarction patients. Many caregivers suffer from posttraumatic stress disorder and emotional stress. Interventions for them are available. Implementation of integrated programs covering both cognitive and cardiac rehabilitation is hampered by lack of knowledge and organizational barriers. SUMMARY: OHCA survivors should be routinely screened for cognitive and emotional problems. When patients with mild cognitive deficits participate in cardiac rehabilitation, their program should be adjusted to their cognitive abilities. For patients with severe cognitive or emotional problems, individualized rehabilitation seems favorable. Integrated rehabilitation treatment between cardiac and cognitive rehabilitation departments is recommended. Attention should be paid to the burden of caregivers.

Association of health insurance with post-resuscitation care and neurological outcomes after return of spontaneous circulation in out-of-hospital cardiac arrest patients in Korea.

BACKGROUND: We investigated the association of health insurance status with post-resuscitation care and neurological recovery in out-of-hospital cardiac arrest (OHCA) and whether the effects changed with age or gender. METHODS: Adult OHCAs with presumed cardiac etiology who had sustained ROSC from 2013 to 2016 were enrolled from the nationwide OHCA registry of Korea. Insurance status was categorized into 2 groups: National Health Insurance (NHI) and Medical Aid (MA). The endpoints were post-resuscitation coronary reperfusion therapy (CRT), targeted temperature management (TTM), and good neurological recovery (cerebral performance category of 1 or 2). Multivariable logistic regression models and interaction analyses (insurance × age and insurance × gender) were conducted for adjusted odds ratios (aORs) and 95% confidence intervals (CI). RESULTS: Of a total of 19,865 eligible OHCA patients, 18,119 (91.2%) were covered by NHI and 1746 (8.8%) by MA. The MA group was less likely to receive post-resuscitation CRT and TTM (aOR (95% CI): 0.75 (0.59-0.96) for CRT; 0.71 (0.57-0.89) for TTM) and had worse neurological outcomes (0.71 (0.57-0.89)) compared with the NHI group. In the interaction analyses, MA was associated with less CRT and good neurological recovery in the 45-64 year old group (0.54 (0.37-0.77) for CRT; 0.70 (0.51-0.95) for neurological outcome) and in the male group (0.69 (0.52-0.91) for CRT; 0.77 (0.61-0.97) for TTM; 0.70 (0.53-0.92)) for neurological outcome). CONCLUSIONS: There were disparities in post-resuscitation care and substantial neurological recovery by health insurance status, and the disparities were prominent in middle-aged adults and males. Increasing health insurance coverage for post-resuscitation care should be considered.

[Are the initial pH and the lactate values after cardiopulmonary resuscitation always crucial?] / Sind initialer pH- und Laktatwert nach kardiopulmonaler Wiederbelebung immer entscheidend?

A 52-year-old man suffered an out-of-hospital cardiac arrest (OHCA) and bystander reanimation was immediately started. The initial electrocardiogram indicated ventricular fibrillation. After repetitive defibrillations as well as intravenous administration of amiodarone, a temporary return of spontaneous circulation (ROSC) could be established. Due to unstable cardiovascular conditions with recurrence of ventricular fibrillation, mechanical resuscitation with the help of the LUCAS™ device was initiated, and the patient was admitted to our hospital for emergency coronary angiography after a cumulative period of approximately 90 min. The initial blood gas analysis displayed a significant lactate acidosis with a pH value of 6.7. Therefore, in a multidisciplinary team, the decision was made against an extracorporeal membrane oxygenation and for a coronary angiography under continuation of mechanical resuscitation. After multiple stenting of the right coronary artery and left anterior descending coronary artery, permanent ROSC could be established. The patient was admitted to our intensive care unit, where he was further treated according to the S3-guideline for infarct-related cardiogenic shock. In the course of time, the patient was quickly extubated without any neurological deficits.

Detailed analysis of health-related quality of life after out-of-hospital cardiac arrest.

AIM: To describe the detailed health-related quality of life (HRQoL) in survivors from the TTM-trial and to investigate potential differences related to sex and age. METHODS: This is a cross-sectional study originating from a large prospective international, multicentre trial, including 442 respondents who answered the Short Form-36 item Questionnaire Health Survey version 2® (SF-36v2®) at a structured follow-up 6 months after out-of-hospital cardiac arrest (OHCA). Statistical analysis between independent groups were performed with Mann-Whitney U or Chi-square. Age was analysed primarily as a dichotomised variable. RESULTS: Although overall physical and mental health were within the normal range, a substantial proportion of respondents had impaired function at domain-specific levels, particularly in Role-Physical (50%) and Role-Emotional (35%). Females scored significantly lower than males in; Physical Functioning (41.7 vs. 47.9, p < 0.001), Role-Physical (40.4 vs. 44.3, p = 0.02), General Health (47.0 vs. 50.5, p = 0.02), Vitality (47.2 vs. 52.7, p < 0.001), and Role-Emotional (41.5 vs. 46.2, p = 0.009). Those ≤65 years scored significantly better in Physical Functioning (47.9 vs. 44.1 p < 0.001), while those >65 years scored significantly better in Vitality (50.8 vs. 53.7, p = 0.006) and Mental Health (50.3 vs. 52.6, p = 0.04). CONCLUSIONS: Many OHCA survivors demonstrated impaired function in HRQoL at a domain level, despite most patients reporting an acceptable general HRQoL. Females reported worse HRQoL than males. Older age was associated with a worse Physical Functioning but better Vitality and Mental Health. Role-Physical and Role-Emotional aspects of health were especially affected, even when effects of age and sex where accounted for.

Determining the motivations of family members to undertake cardiopulmonary resuscitation training through grounded theory.

AIMS: To explore the motivation of family members of patients at high risk for sudden cardiac death for undertaking cardiopulmonary resuscitation (CPR) training. BACKGROUND: Home cardiac arrests are associated with poor outcomes because few family members learn CPR. Little is known about factors that motivate family members to participate in CPR training. DESIGN: We used grounded theory to establish a theoretical framework to explore the motivational factors for learning CPR among family members. METHODS: Twelve participant observations and 42 semi-structured interviews with family members of different behaviours towards CPR training were conducted from December 2013 - November 2016. Data were analysed using constant-comparisons, situational analysis, and encoding. FINDINGS: A motivation-behaviour theoretical framework for learning CPR was constructed. We identified meeting inner needs as the core category to demonstrate motivation. Security motivation and responsibility motivation emerged as main categories, which demonstrate that seeking a sense of security and shouldering family responsibility were important considerations for family members to learn CPR. These two motivations produced high-engagement behaviours of family members to learn CPR. CONCLUSIONS: The motivations we identified-deriving from a sense of security and family responsibility-are the main reasons family members would learn CPR and, therefore, should be understood by medical professionals. Understanding these motivations may help in the formulation of customized CPR training that further meets the needs of family members. For example, motivational interventions that are integrated with a family-based CPR course can be designed to improve the participation of family members and the sustainability of the course.

Factors Associated with the Transfer Decision in Resuscitated Patients with Out-of-Hospital Cardiac Arrest Presenting to a Hospital with Limited Targeted Temperature Management Capability in Korea.

This study aimed to identify factors associated with the decision to transfer resuscitated patients with out-of-hospital cardiac arrest (OHCA) who were initially examined at hospitals with limited targeted temperature management capability (HLTC) in Korea. We included adult patients with OHCA who were initially transported to HLTC from 2012 to 2015. We limited the study population with OHCA who were admitted or transferred. Potential factors associated with the transfer decision were categorized as patient- or hospital-level characteristics. The primary outcome was emergency department disposition: transfer out versus admission to HLTC. A stepwise multivariable logistic regression analysis was conducted to identify factors associated with the outcome. Of the 64,696 patients with OHCA, 37,705 (58.3%) were initially transported to HLTC. Approximately 44.7% of patients were transferred out. In terms of patient-level factors, age, socioeconomic status, and initial electrocardiogram rhythm were associated with the transfer decision. Hospital factors, such as percutaneous coronary intervention capability of HLTC (adjusted odds ratio = 0.16; 95% confidence interval = 0.14-0.19) and location of the metropolitan or urban hospital, were negatively associated with the transfer decision. Several hospital and patient factors were associated with the decision to transfer out patients with OHCA who were initially examined at HLTC.

Observatory of elderly people cared in pre-hospital.

INTRODUCTION: Emergency medical services (EMS) supports an increasing number of elderly patients. AIM: To evaluate outcome and autonomy of patients aged 65 and older who  managed in the prehospital theater. METHODS: We conducted a prospective observational multicenter study over one year (October 2015 -September 2016). We included patients aged 65 or older managed in the pre hospital setting. We studied: demographic criteria, pre-hospital care, severity (IGSA score and GCS), baseline and 3-month autonomy was assessed using the Katz score. Multivariate analysis was performed to identify predictive factors of mortality at 24 hours. RESULTS: we included 385 patients. Average age was 81 ± 8 years and sex ratio was equal to 1.08. Thirty eight (10%) patients were in cardiac arrest at the arrival of EMS team and 50% of them were resuscitated without recuperation. The IGSA score was 7 [5-10] on the initial examination versus 6  [4-7] on the arrival at the hospital (p<0.01). Baseline autonomy was 2 [0-6] versus 3 [0-6] at 3 months with p = 0.02. Ninety four patients (33%) regained their  baseline autonomy after the acute episode. At 24 hours the mortality rate was 9% (n=32). In multivariate analysis, the independent predictor factor of  mortality was GCS <8 with an adjusted OR=9,22 ;95%CI[3,44-24,70] ; p<0.001. CONCLUSION: Except out of hospital cardiac arrest, the survival of elderly subjects managed by EMS teams was encouraging. In the medium term, one-third of them regained their autonomy after the acute episode. These elements suggest successful integration into the emergency system.

'Thunder bolts and lightning': survival and neurorehabilitation following out of hospital cardiac arrest secondary to lightning strike.

BACKGROUND: There is a limited evidence base to inform patient management following lightning-induced injuries. CASE REPORT: A 36-year-old right-handed Caucasian male struck by lightning while outdoors suffered an out-of-hospital cardiac arrest with a recorded 50-min interval before the restoration of spontaneous circulation. Multiple life threatening injuries were sustained and a profound peripheral neuropathy developed. Cognitively, he was remarkably intact. We document his acute admission and his recovery during an inpatient stay in a UK-based Neurorehabilitation Unit. CONCLUSION: Intensive neurorehabilitation in this case improved functional independence and facilitated neuropsychological recovery, to the point that our patient was discharged to independent living. This case offers some support to the hypothesis that the electrical activity of a lightning strike can be both cardioprotective and neuroprotective, and that prolonged cardiopulmonary resuscitation is warranted in such cases.

Return to Work and Participation in Society After Out-of-Hospital Cardiac Arrest.

BACKGROUND: The aim of this study was to describe out-of-hospital cardiac arrest (OHCA) survivors' ability to participate in activities of everyday life and society, including return to work. The specific aim was to evaluate potential effects of cognitive impairment. METHODS AND RESULTS: Two hundred eighty-seven OHCA survivors included in the TTM trial (Target Temperature Management) and 119 matched control patients with ST-segment-elevation myocardial infarction participated in a follow-up 180 days post-event that included assessments of participation, return to work, emotional problems, and cognitive impairment. On the Mayo-Portland Adaptability Inventory-4 Participation Index, OHCA survivors (n=270) reported more restricted participation In everyday life and in society (47% versus 30%; P<0.001) compared with ST-segment-elevation myocardial infarction controls (n=118). Furthermore, 27% (n=36) of pre-event working OHCA survivors (n=135) compared with 7% (n=3) of pre-event working ST-segment-elevation myocardial infarction controls (n=45) were on sick leave (odds ratio, 4.9; 95% confidence interval, 1.4-16.8; P=0.01). Among the OHCA survivors assumed to return to work (n=135), those with cognitive impairment (n=55) were 3× more likely (odds ratio, 3.3; 95% confidence interval, 1.2-9.3; P=0.02) to be on sick leave compared with those without cognitive impairment (n=40; 36%, n=20, versus 15%, n=6). For OHCA survivors, the variables that were found most predictive for a lower participation were depression, restricted mobility, memory impairment, novel problem-solving difficulties, fatigue, and slower processing speed. CONCLUSIONS: OHCA survivors reported a more restricted societal participation 6 months post-arrest, and their return to work was lower compared with ST-segment-elevation myocardial infarction controls. Cognitive impairment was significantly associated with lower participation, together with the closely related symptoms of fatigue, depression, and restricted mobility. These predictive variables may be used during follow-up to identify OHCA survivors at risk of a less successful recovery that may benefit from further support and rehabilitation. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01946932.

Efectividad de un programa formativo en reanimación cardiopulmonar en docentes de educación secundaria en el medio rural. Estudio piloto / A pilot study on the effectiveness of a training program in cardiopulmonary resuscitation for high school teachers in rural areas

Objetivo. Evaluar la eficacia de un programa formativo en reanimación cardiopulmonar con manejo de desfibrilador externo semiautomático en docentes de un Instituto de Educación Secundaria en el medio rural. Metodología. Estudio cuasiexperimental mediante muestreo por conveniencia. La duración total del programa formativo fue de 10 horas repartidas en 4 sesiones. Al inicio y final del programa formativo se administró a todos los participantes un cuestionario con 5 preguntas. Participantes. 15 docentes de un Instituto de Educación Secundaria perteneciente a la provincia de Teruel. Emplazamiento. Las sesiones formativas se llevaron a cabo en el propio instituto. Mediciones principales. Se utilizó el programa SPSS versión 21, con un IC del 95 %. Se realizó un análisis descriptivo: para variables cuantitativas (media y DE±) y para variables cualitativas frecuencias y porcentajes. Resultados. Un 73.3 % de los participantes fueron mujeres y un 26.7 % hombres. La media de edad de los participantes fue de 44.8 años. En el cuestionario pretest se observó que un 93.4 % de los participantes obtuvieron calificaciones de «no apto» y tan solo un 6.7 % obtuvo una calificación de «apto». En el cuestionario de evaluación postest se observó que el 100 % de los participantes obtuvieron calificaciones de «apto». La prueba de Wilcoxon constata que el programa formativo consiguió una eficacia elevada. Conclusiones. Los programas formativos pueden servir para estimular el desarrollo de nuevos programas de formación. Este tipo de formaciones resultan efectivas y deberían formar parte en la educación obligatoria en España (AU)

Objective. To evaluate the effectiveness of a training program in cardiopulmonary resuscitation, targeting high school teachers in rural areas for semi-automated external defibrillator management. Methodology. Quasi-experimental study using convenience sampling. The program lasted 10 hours, distributed among 4 sessions. At the beginning and end of the training program all participants answered a 5-issue questionnaire, which rated them as «suitable» or «unfit» to perform cardiorespiratory resuscitation. Participants. 15 high school teachers from Teruel province. LOCATION. The training sessions were conducted at the school premises. Main measurements. Program SPSS version 21 was used. The confidence interval was of 95 %. A descriptive analysis for quantitative (mean and SD ±) variables, qualitative variables, frequencies and percentages was performed. Results. 73.3 % of participants were women and 26.7 % men. The average age of participants was 44.8 years. For the pre-test questionnaire, 93.4 % of participants received «unfit» grades and only 6.7 % were rated as «suitable». In the posttraining evaluation questionnaire, 100 % of participants were graded as «suitable». Wilcoxon test established that the training program was highly efficient. Conclusions. Training programs make a difference in the capacity to correctly perform life-saving interventions. They also stimulate the development of new and better training programs. Such trainings are very effective and should be included as part of Spain’s compulsory education (AU)

Actitud y autopercepción de la población en la cadena de supervivencia / Attitude and self-perception of the population in the chain of survival

Objetivo: analizar la actitud y autopercepción de la población en la cadena de supervivencia, junto con la formación recibida en reanimación cardiopulmonar (RCP) y los factores que condicionan el inicio de esta por parte de la población. Método: estudio descriptivo observacional con 364 pacientes que acudieron a una consulta de anestesia. Instrumento para la recogida de los datos: cuestionario de elaboración propia. Variables de estudio: disposición a realizar RCP, autoeficacia percibida para llevarla a cabo, factores que condicionan el inicio de una RCP, formación en la materia y su reacción ante una parada cardiorrespiratoria (PCR). Para el análisis bivariado se utilizó la Chi cuadrado. Resultados: un 70% no sabía qué es la cadena de supervivencia. El 80,6% contestó estar dispuesto a hacer RCP a un desconocido, pero solo el 25,9% se sentía preparado para hacerlo. En cuanto a los factores que interfieren en su inicio, el 64,2% señaló la falta de conocimientos y el 60,3% el sentimiento de responsabilidad. Solo el 32% de los encuestados recibió alguna vez formación en RCP. Un 99,7% consideraba importante que se entrene a la población, y también en los colegios, sobre RCP. Entre las personas formadas era mayor la autoeficacia percibida, la disposición a actuar y el número de personas que iniciarían maniobras de reanimación ante una PCR. Conclusiones: la disposición para hacer RCP es buena, pero la autoeficacia percibida para hacerla no, debido a la falta de formación que, junto con el sentimiento de responsabilidad, ocasiona que no la inicien (AU)

Objective: to analyze the attitude and self-perception of the population in the chain of survival, as well as the training received on cardiopulmonary resuscitation (CPR), and the factors that might have an impact on its initiation by the population. Method: an observational descriptive study on 364 patients who attended an anesthesia unit. The data collection tool was a self-prepared questionnaire. Study variables: willingness to conduct CPR, self-efficacy perceived in order to conduct it, factors with impact on CPR initiation, training on the matter, and their reaction when faced with cardiac arrest (CA). Chi square was used for bivariate analysis. Results: a 70% of patients were not familiar with the chain of survival; 80.6% answered that they were willing to conduct CPR on an unknown person, but only 25.9% felt they had the adequate training. In terms of the factors interfering in its initiation, 64.2% of patients pointed out to lack of knowledge, and 60.3% to a feeling of responsibility. Only 32% of the surveyed patients had ever received some CPR training; 99.7% considered it would be important to train the population on CPR; and also in schools. Among trained persons, there was a higher self-perceived efficacy, willingness to act, and number of persons who would initiate resuscitation manoeuvres when faced with CPR. Conclusions: the willingness to conduct CPR is good, but the self-efficacy perceived is not, due to the lack of training that, together with the feeling of responsibility, leads to non-initiation (AU)

[Post-resuscitation care after out-of-hospital cardiac arrest].

Survival from out-of-hospital cardiac arrest in Denmark has increased significantly since 2001, and important improvements have been made in the post-resuscitation care. The aim of this article is to summarize the most recent international guidelines for post-resuscitation care in a Danish perspective. The main aspects concern securing haemodynamic and respiratory functions and performing urgent coronary catheterization and targeted temperature management in selected patients. In prognostication a multi-modal approach should be applied.

[Relevance of Living Wills During Post-Resuscitation Care]. / Stellenwert der Patientenverfügung in der Postreanimationsbehandlung.

Background There is hardly any evidence about the influence of living wills on acute life-threatening disease like out-of-hospital cardiac-arrest (OHCA). We therefore initiated this study to quantify the percentage of victims of OHCA who's living wills are available during post-resuscitation care. Methods All victims of OHCA who were admitted to our hospital between January 1st 2008 and July 31th 2016 were identified by analysis of our central admission register. Data from individual patients were collected from the patient's health records and anonymously stored on a central database. Results Altogether, there were 343 victims of OHCA admitted to our hospital between January 1st 2008 and July 31th 2016, including 16 patients (4.7 %) with living wills and 18 patients (5.2 %) with legal health care proxy. Survival rates were 31.2 % in patients with living wills, 27.8 % in patients with legal health care proxy and 33.3 % in patients without such a document. Conclusion In this study, the percentage of victims of OHCA with available living wills during post-resuscitation care was low. The presentation of living wills or legal health care proxies during post-resuscitation care of victims from OHCA was not equivalent to the patient`s death. Most often, discussion with relatives led to the decision to withdraw further therapy.

Out-of-hospital cardiac arrest survivors with cognitive impairments have lower exercise capacity.

BACKGROUND: Hypoxic brain injury is described in up to 40% of survivors after out-of-hospital cardiac arrest (OHCA). Besides cognitive impairments, lack of circulation may also affect exercise capacity. It is not known if exercise capacity of patients with cognitive impairments differs from other OHCA survivors. METHODS: This retrospective cohort study included patients ≥18 years with myocardial infarction (MI) as cause of OHCA admitted for cardiac rehabilitation between February 2011 and April 2014. Data in socio-demographic, OHCA and medical interventions were retrieved. Cognitive functioning was determined with the Mini-Mental State Examination, Cognitive Failures Questionnaire and the Informant Questionnaire on Cognitive Decline in the Elderly. Exercise capacity (VO2peak), workload (Watts) and blood pressure (mmHg) were measured at maximum cardiopulmonary exercise. Heart rate (bpm) was measured at rest and maximum exercise and Metabolic Equivalents of Tasks (MET) were calculated. RESULTS: 65 patients after OHCA caused by MI were included (85% male, median age 60years). Of 53 patients Cardio Pulmonary Exercise Test data was available of which nine patients showed cognitive impairments. Significant differences (p<0.05) in exercise capacity were found between patients with and without cognitive impairments: VO2peak (median 14.5 vs 19.7ml/kg/min), workload (median 130.0 vs 143.5W) and MET's (median 4.1 vs 5.6). CONCLUSION: Based on this small study, there seems to be a correlation between cognitive impairments and lower exercise capacity in patients referred for rehabilitation after OHCA caused by MI. It seems sensible for rehabilitation programs to take the lower exercise capacity of patients with cognitive impairments into account.

Predictors of long-term functional outcome and health-related quality of life after out-of-hospital cardiac arrest.

BACKGROUND: Even if a large majority of out-of-hospital cardiac arrest (OHCA) survivors appear to have a good neurological recovery with no important sequellae, whether health-related quality of life (HRQOL) is altered is less explored. PATIENTS AND METHODS: HRQOL was evaluated by telephone interview using SF-36 questionnaire. Each OHCA case was age and gender-matched with 4 controls from the French general population. Association between current condition of the survivors with the 8 dimensions of the SF-36 questionnaire was investigated using MANCOVA. Cluster analysis was performed to identify patterns of HRQOL among CPC1 survivors. RESULTS: 255 patients discharged alive from our referral centre between 2000 and 2013 (median age of 55y [45,64], 73.7% males) were interviewed. Global physical and mental components did not differ between CPC 1 survivors and controls (47.0 vs. 47.1, p=0.88 and 46.4 vs. 46.9, p=0.45) but substantially differed between CPC2, CPC3 and the corresponding controls. Younger age, male gender, good neurological recovery and daily-life autonomy at telephone interview were significantly associated with better scores in each SF-36 dimensions. Cluster analysis individualized 4 distinct subgroups of CPC1 patients characterised by progressively increased score of SF-36. Return to work and daily-life autonomy were differently distributed across these 4 groups while pre-hospital Utstein variables were not. CONCLUSION: HRQOL of CPC1 OHCA survivors appeared similar to that of the general population, but patients with CPC2 or 3 had altered HRQOL. Younger age, male gender, good neurological recovery and daily-life autonomy were independently associated with a better HRQOL.

Cognitive problems in patients in a cardiac rehabilitation program after an out-of-hospital cardiac arrest.

OBJECTIVE: Estimate prevalence of cognitive problems due to hypoxic brain injury in out-of-hospital cardiac arrest (OHCA) survivors referred for cardiac rehabilitation and association with quality of life as well as autonomy and participation. DESIGN: Prospective cohort study. METHOD/DESIGN: Consecutive OHCA patients. The Mini-Mental State Examination (MMSE), Cognitive Failures Questionnaire (CFQ) and Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) were administered 4 weeks after the OHCA. Cognitive problems were defined if MMSE <28, CFQ >32 or IQCODE >3.6. The Impact on Participation and Autonomy Questionnaire (IPAQ) (participation/autonomy), the SF-36 Health Survey (SF-36) (quality of life) and the Hospital Anxiety Depression Scale (HADS) (anxiety/depression) were administered. Correlations between cognitive problems and participation/autonomy and quality of life were calculated. RESULTS: 63 of 77 patients were male (82%), median age 59 years (range 15-84). MMSE median 29 (interquartile range 28-30), CFQ mean 20.9 (SD 9.4) and IQCODE mean 3.1 (SD 0.2). Eighteen patients (23%) scored positive for cognitive problems. Significant correlations were found between MMSE and IPAQ: autonomy inside (r = -0.38), family role (r = -0.26), autonomy outside (r = -0.32), social relations (r = -0.38) and social functioning (r = 0.32). MMSE was related to SF-36: social functioning (r = 0.32). The CFQ was related to IPAQ: autonomy outdoors (r = 0.29) and SF-36: bodily pain (r = -0.37), vitality (r = -0.25), mental health (r = -0.35) and role emotional (r = -0.40). The IQCODE was related to IPAQ: autonomy indoors (r = 0.26) and to SF-36: vitality (r = -0.33) and social functioning (r = -0.41). CONCLUSION: Twenty-three percent of the patients referred for cardiac rehabilitation showed cognitive problems. Associations were found between cognitive problems and several aspects of participation/autonomy and perceived quality of life.

Impact of early interventions by a cardiac rehabilitation team on the social rehabilitation of patients resuscitated from cardiogenic out-of-hospital cardiopulmonary arrest.

OBJECTIVE: We examined the effects of intervention performed by a multidisciplinary cardiac rehabilitation (CR) team on the social rehabilitation of patients with cardiogenic out-of-hospital cardiopulmonary arrest (OHCA) in the acute phase. METHODS: This study included 122 patients who were resuscitated after cardiogenic OHCA during a 10-year period. They were divided into two groups: including a non-CR group of patients (n=58) who were admitted before the CR team started performing systematic intervention and a CR group (n=64) who were admitted after the intervention was initiated. The following items were examined for each group: treatment condition at onset, contents of treatment, primary disease, presence or absence of underlying disease, presence or absence of complications, general physical and neurological outcome, duration of hospital stay, and status of social rehabilitation. RESULTS: Although the number of patients with cardiogenic OHCA did not markedly change, the number of bystanders participating in cardiopulmonary resuscitation (CPR) was significantly higher in the CR group versus the non-CR group (p<0.01). The effect of bystanders participating in CPR also significantly reduced the mortality outcome (p<0.05 versus the group without CPR), and patients in the CR group were more likely to achieve social rehabilitation (p<0.05 versus the group without CPR). Moreover, the number of patients who returned to society one year later was increased in the CR group versus the non-CR group (p<0.05). The incidence of respiratory complications was also significantly lower in the CR group versus the non-CR group (p<0.05). CONCLUSION: Along with the usefulness of rapid pre-hospital aid, our results suggest that systemic intervention performed by the CR team administered while the patient was in the acute phase may have promoted social rehabilitation of patients resuscitated after cardiogenic OHCA.

Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest.

BACKGROUND: Out-of-hospital cardiac arrest (OHCA) is a significant global health problem. There has been considerable investment in improving the emergency medical response to OHCA, with associated improvements in survival. However, concern remains that survivors have a poor quality of life. This study describes the quality of life of OHCA survivors at 1-year postarrest in Victoria, Australia. METHODS AND RESULTS: Adult OHCA patients who arrested between 2010 and 2012 were identified from the Victorian Ambulance Cardiac Arrest Registry. Paramedics attended 15 113 OHCA patients of which 46.3% received an attempted resuscitation. Nine hundred and twenty-seven (13.2%) survived to hospital discharge of which 76 (8.2%) died within 12 months. Interviews were conducted with 697 (80.7%) patients or proxies, who were followed-up via telephone interview, including the Glasgow Outcome Scale-Extended, the 12-item short form health survey, and the EuroQol. The majority (55.6%) of respondents had a good recovery via the Glasgow Outcome Scale-Extended≥7 (41.1% if patients who died postdischarge were included and nonrespondents were assumed to have poor recovery). The mean EuroQol index score for respondents was 0.82 (standard deviation, 0.19), which compared favorably with an adjusted population norm of 0.81 (standard deviation, 0.34). The mean 12-item short form Mental Component Summary score for patients was 53.0 (standard deviation, 10.2), whereas the mean Physical Component Summary score was 46.1 (standard deviation, 11.2). CONCLUSIONS: This is the largest published study assessing the quality of life of OHCA survivors. It provides good evidence that many survivors have an acceptable quality of life 12 months postarrest, particularly in comparison with population norms.

Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study.

BACKGROUND: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. AIM: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. METHODS: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw's inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients' cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients' neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. RESULTS: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequent in the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. CONCLUSIONS: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.