Clinical review: Beyond immediate survival from resuscitation – long-term outcome considerations after cardiac arrest

Abstract

A substantial body of literature concerning resuscitation from cardiac arrest now exists. However, not surprisingly, the greater part concerns the cardiac arrest event itself and optimising survival and outcome at relatively proximal time points. The aim of this review is to present the evidence base for interventions and therapeutic strategies that might be offered to patients surviving the immediate aftermath of a cardiac arrest, excluding components of resuscitation itself that may lead to benefits in long-term survival. In addition, this paper reviews the data on long-term impact, physical and neuropsychological, on patients and their families, revealing a burden that is often underestimated and underappreciated. As greater numbers of patients survive cardiac arrest, outcome measures more sophisticated than simple survival are required. IntroductionSurvival to a particular time after an 'index' cardiac arrest event, as recommended by the Utstein guidelines [1], is the most commonly reported outcome measure for resuscitation, with hospital discharge and 1-year survival often reported. Excessive mortality risk is greatest within the first year after arrest and, after 2 years, approaches that of an age-and gender-matched population [2]. A retrospective review of inhospital mortality identified neurological injury as the mode of early death in two thirds of out-of-hospital cardiac arrest (OOHCA) patients admitted to intensive care. Cardiovascular death and multi-organ failure death accounted for the remainder [3]. A number of studies have investigated survival rates at greater than 1 year and how survival following OOHCA has changed over time. Such studies suggest that longer-term survival figures are improving [4][5][6][7]. This may be due to changes in coronary artery disease patterns, resuscitation practice, and/or subsequent medical intervention.With greater numbers of patients now surviving for longer periods, survival alone may be an inadequate assessment of resuscitation and post-resuscitation care. A more suitable tool may be assessment of quality of life (QOL) after hospital discharge. This requires an understanding of the psychosocial impact of cardiac arrest and its sequelae on the survivor and associated family members.The aim of this review is to present the evidence base for interventions and therapeutic strategies that might be offered to patients surviving the immediate aftermath of an OOHCA (excluding components of resuscitation itself) which may lead to benefits in long-term survival. In addition, this paper reviews the data on long-term impact, both physical and neuropsychological, on patients and their families. MethodologySearch terms recommended by the American Heart Association [8] and International Liaison Committee on Resuscitation (ILCOR) were used. These were used by working parties evaluating evidence for the ILCOR 2005 Consensus statement [9].An electronic search of the literature by means of PubMed was conducted using MeSH (Medical Subject Heading) main search terms 'heart a...

Relevance of cognition to health-related quality of life in good-outcome survivors of out-of-hospital cardiac arrest

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