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Rey JR, Caro-Codón J, Rodríguez Sotelo L, López-de-Sa E, Rosillo SO, González Fernández Ó, Fernández de Bobadilla J, Iniesta ÁM, Peña Conde L, Antorrena Miranda I, Armada E, Ruiz Cantador J, López-Sendón JL. Long term clinical outcomes in survivors after out-of-hospital cardiac arrest. Eur J Intern Med 2020; 74:49-54. [PMID: 31859025 DOI: 10.1016/j.ejim.2019.11.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/13/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION AND OBJECTIVES Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events. METHODS Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up. RESULTS A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9-69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578-7.777)], non-shockable rhythm [HR 2.926 (1.390-6.163)], time to onset of CPR [HR 1.063 (0.997-1.134)], older age [1.036 (1.008-1.064)) and worse ejection fraction at discharge [1.033 (1.009-1.058)]. CONCLUSIONS Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.
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Affiliation(s)
- Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain.
| | - Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Laura Rodríguez Sotelo
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Esteban López-de-Sa
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Óscar González Fernández
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | | | - Ángel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Laura Peña Conde
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Isabel Antorrena Miranda
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - Eduardo Armada
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José Ruiz Cantador
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
| | - José Luis López-Sendón
- Cardiology Department, Hospital Universitario La Paz, C/ Paseo de la Castellana, 261, 28046 Madrid, Spain
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Caro-Codón J, Rey JR, Lopez-de-Sa E, González Fernández Ó, Rosillo SO, Armada E, Iniesta ÁM, Fernández de Bobadilla J, Ruiz Cantador J, Rodríguez Sotelo L, Irazusta FJ, Rial Bastón V, Merás Colunga P, López-Sendón JL. Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management. Resuscitation 2018; 133:33-39. [PMID: 30253227 DOI: 10.1016/j.resuscitation.2018.09.015] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND This study aimed to assess long-term cognitive and functional outcomes in out-of-hospital cardiac arrest (OHCA) patients treated with targeted-temperature management, investigate the existence of prognostic factors that could be assessed during initial admission and evaluate the usefulness of classic neurological scales in this clinical scenario. METHODS Patients admitted due to OHCA from August 2007 to November 2015 and surviving at least one year were included. Each patient completed a structured interview focused on the collection of clinical, social and demographic data. All available information in clinical records was reviewed and a battery of neurocognitive and psychometric tests was performed. RESULTS Seventy-nine patients were finally included in the analysis. Forty-three patients (54.4%) scored below the usual cut-off points for the diagnosis of mild cognitive impairment, even though most of these deficits went unnoticed when patients were assessed using CPC and modified Rankin scale. Nineteen (24%) developed certain degree of impairment in their attention capacity and executive functions. A significant proportion developed new memory-related disorders (43%), depressive symptoms (17.7%), aggressive/uninhibited behavior (12.7%) and emotional lability (8.9%). A greater number of weekly hours of intellectual activity and a qualified job were independent protective factors for the development of cognitive impairment. However, being older at the time of the cardiac arrest was identified as a poor prognostic factor. CONCLUSIONS There is a high prevalence of long-term cognitive deficits and functional limitations in OHCA survivors. Most commonly used clinical scales in clinical practice are crude and lack sensitivity to detect most of these deficits.
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Affiliation(s)
- Juan Caro-Codón
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain.
| | - Juan R Rey
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | | | - Sandra O Rosillo
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Eduardo Armada
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Ángel M Iniesta
- Cardiology Department, Hospital Universitario La Paz, Madrid, Spain
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