• Resuscitation · Aug 2014

    Predictors of long-term survival after out-of-hospital cardiac arrest: The impact of activity of daily living and Cerebral Performance Category scores.

    • Gal Pachys, Nechama Kaufman, Tali Bdolah-Abram, Jeremy D Kark, and Sharon Einav.
    • Hebrew University-Hadassah Faculty of Medicine, Ein Kerem, Jerusalem, Israel; Paramedic, Magen David Adom, Jerusalem, Israel.
    • Resuscitation. 2014 Aug 1;85(8):1052-8.

    BackgroundCurrent focus on immediate survival from out-of-hospital cardiac arrest (OHCA) has diverted attention away from the variables potentially affecting long-term survival.AimTo determine the relationship between neurological and functional status at hospital discharge and long-term survival after OHCA.MethodsProspective data collection for all OHCA patients aged >18 years in the Jerusalem district (n=1043, 2008-2009).Primary Outcome MeasureLength of survival after OHCA. Potential predictors: Activities of Daily Living (ADL) and Cerebral Performance Category (CPC) scores at hospital discharge, age and sex.ResultsThere were 52/279 (18.6%) survivors to hospital discharge. Fourteen were discharged on mechanical ventilation (27%). Interviews with survivors and/or their legal guardians were sought 2.8±0.6 years post-arrest. Eighteen died before long-term follow-up (median survival 126 days, IQR 94-740). Six improved their ADL and CPC scores between discharge and follow-up. Long-term survival was positively related with lower CPC scores (p=0.002) and less deterioration in ADL from before the arrest to hospital discharge (p=0.001). For each point increment in ADL at hospital discharge, the hazard ratio of death was 1.31 (95%CI 1.12, 1.53, p=0.001); this remained unchanged after adjustment for age and sex (HR 1.26, 95%CI 0.07, 1.48, p=0.005).ConclusionsOne-third of the patients discharged from hospital after OHCA died within 30 months of the event. Long-term survival was associated both with better neurological and functional level at hospital discharge and a smaller decrease in functional limitation from before to after the arrest, yet some patients with a poor neurological outcome survived prolonged periods after hospital discharge.Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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