• K H Ladwig, A Schoefinius, G Dammann, R Danner, R Gürtler, and R Herrmann.
• Institut und Poliklinik für Psychosomatische Medizin, Med. Psychologie und Psychotherapie, Technischen Universität München, Germany. kh.ladwig@lrz.tu-muenchen.de
• Am J Psychiatry. 1999 Jun 1;156(6):912-9.

ObjectiveProgress in resuscitation medicine allows an increasing proportion of patients to survive an out-of-hospital cardiac arrest. However, little is known about long-term adaptation to the vital breakdown. The present study assessed the long-term prevalence and severity of emotional disability of cardiac arrest survivors and ascertained whether survivors suffer from recurrent and intrusive recollections of the cardiac arrest.MethodFollow-up analysis was performed on all cardiac arrest survivors discharged from the hospital over a 5-year interval (1990-1994) in a defined inner city and suburban area. From 118 initially hospitalized cardiac arrest survivors, 45 patients were discharged alive from the hospital. After a mean follow-up period of 39 months (range = 22-64), 25 patients exhibited sufficient cerebral performance for psychodiagnostic assessment; 21 patients were assessed.ResultsDespite an impaired ability to concentrate, cardiac arrest survivors had levels of psychological adjustment at follow-up that were similar to those of 35 cardiac patients whose clinical course was not complicated by cardiac arrest. However, the diagnosis of psychotraumatic symptoms in cardiac arrest survivors led to a sharp separation between favorable and nonfavorable outcome in affective regulation and level of functioning. Of the cardiac arrest patients, those with high scores of intrusion and avoidance (N = 8) reported an enduring sense of demoralization with significantly more somatic complaints, depression, anxiety, lack of confidence in the future, and narrowing of social activities than those with low scores (N = 11). Long-acting sedation at illness onset significantly predicted a favorable outcome.ConclusionsThis study provides the first empirical evidence that the application of the posttraumatic stress disorder paradigm in the long-term evaluation of cardiac arrest survivors significantly contributes to defining a patient population at high risk for serious emotional disability.

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