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Southern C, Tutton E, Dainty KN, Seers K, Pearson NA, Couper K, Ellard DR, Perkins GD, Haywood KL. The experiences of cardiac arrest survivors and their key supporters following cardiac arrest: A systematic review and meta-ethnography. Resuscitation 2024; 198:110188. [PMID: 38548009 DOI: 10.1016/j.resuscitation.2024.110188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
AIM To review qualitative studies on the experience of sudden cardiac arrest survival from the perspective of both survivors and their key supporters, including family/close friends. METHODS A seven-step meta-ethnography and synthesis of qualitative evidence was undertaken, informed by the Meta-Ethnography Reporting Guidelines (eMERGe). Four major databases were searched (Medline, EMBASE, CINAHL, PsycINFO; January 1995-January 2022, updated July 2023) for qualitative studies exploring survivors' and/or key supporters' experiences of cardiac arrest survival. The Critical Appraisal Skills Programme checklist and Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) were applied to evaluate the overall confidence in research findings. Constructs were identified from each paper, informing theme and sub-theme development. RESULTS From 15,917 unique titles/abstracts and 196 full-text articles, 32 met the inclusion criteria. Three themes captured the survivors' experiences: 1) Making sense of my cardiac arrest; 2) Learning to trust my body and mind; and 3) Re-evaluating my life. A further three themes reflected key supporters' experiences: 1) Emotional turmoil; 2) Becoming a carer: same person but different me; and 3) Engaging with a new and unknown world. However, limited data and some methodological weaknesses in included studies reduced confidence in several themes. The findings were conceived within the overarching concept of 'negotiating a new normal'. CONCLUSIONS The enduring psychosocial and physical sequelae of cardiac arrest survival substantially impacts the lives of survivors and their key supporters, requiring negotiation of their 'new normality'. The need for sense-making, physical and psychological recovery, and the new roles for key supporters should be strong considerations in the development of future interventions.
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Affiliation(s)
- Charlotte Southern
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Elizabeth Tutton
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England; Kadoorie, Oxford Trauma Research and Emergency Care, NDORMS, Oxford University, UK; Major Trauma Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford UK
| | - Katie N Dainty
- Office of Research & Innovation, North York General Hospital, Toronto Ontario Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Kate Seers
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Nathan A Pearson
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England; University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Gavin D Perkins
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kirstie L Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England.
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Harrod M, Hauschildt K, Kamphuis LA, Korpela PR, Rouse M, Nallamothu BK, Iwashyna TJ. Disrupted Lives: Caregivers' Experiences of In-Hospital Cardiac Arrest Survivors' Recovery 5 Years Later. J Am Heart Assoc 2023; 12:e028746. [PMID: 37671627 PMCID: PMC10547269 DOI: 10.1161/jaha.122.028746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 04/25/2023] [Indexed: 09/06/2023]
Abstract
Background Survivors of in-hospital cardiac arrest (IHCA) experience ongoing physical and cognitive impairments, often requiring support from a caregiver at home afterwards. Caregivers are important in the survivor's recovery, yet there is little research specifically focused on their experiences once the survivor is discharged home. In this study, we highlight how caregivers for veteran IHCA survivors described and experienced their caregiver role, the strategies they used to fulfill their role, and the additional needs they still have years after the IHCA event. Methods and Results Between March and July 2019, semistructured telephone interviews were conducted with 12 caregivers for veteran IHCA survivors. Interviews were transcribed, and content analysis was performed. Patterns within the data were further analyzed and grouped into themes. A predominant theme of "disruption" was identified across 3 different domains including the following: (1) disruption in caregiver's life, (2) disruption in caregiver-patient relationship, and (3) disruption in caregiver's well-being. Disruption was associated with both positive and negative caregiver experiences. Strategies caregivers used and resources they felt would have helped them adjust to their caregiver role were also identified. Conclusions Caregivers for veteran IHCA survivors experienced a disruption in many facets of their lives. Caregivers felt the veterans' IHCA impacted various aspects of their lives, and they continued to need additional support in order to care for the IHCA survivor and themselves. Although some were able to procure coping strategies, such as counseling and engaging in stress-relieving activities, most indicated additional help and resources were still needed.
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Affiliation(s)
- Molly Harrod
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Katrina Hauschildt
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Department of SociologyPopulation Studies CenterUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
| | - Lee A. Kamphuis
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Peggy R. Korpela
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Marylena Rouse
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
| | - Brahmajee K. Nallamothu
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Center for Healthcare Outcomes and PolicyUniversity of MichiganAnn ArborMIUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
| | - Theodore J. Iwashyna
- Lieutenant Colonel Charles S. Kettles VA Medical CenterCenter for Clinical Management ResearchAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineDepartment of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Division of Pulmonary and Critical Care MedicineThe Johns Hopkins University School of MedicineBaltimoreMDUSA
- Department of Internal MedicineUniversity of MichiganAnn ArborMIUSA
- Health Policy and Management, School of Public HealthThe Johns Hopkins UniversityBaltimoreMDUSA
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van Gils P, van Heugten C, Sep S, Moulaert V, Hofmeijer J, Verbunt J. A change of perspective? An explorative study on why patients may not subjectively report cognitive impairments after a cardiac arrest. Resuscitation 2022; 180:59-63. [PMID: 36185035 DOI: 10.1016/j.resuscitation.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/20/2022]
Abstract
AIM Cardiac arrest survivors are at risk of long-term cognitive impairment. Patients with cognitive impairments do not always have cognitive complaints and vice versa. Not reporting cognitive complaints could be caused by a lack of awareness. We hypothesized that caregivers report more cognitive failures than patients, indicating patients' lack of insight into cognitive functioning. METHODS This is a secondary analysis of the Activity and Life After Survival of Cardiac Arrest study on survivors of cardiac arrest and their caregivers. They were assessed at two weeks, three months, and one year after cardiac arrest. At each time point, the patient and the caregiver filled out the cognitive failure questionnaire (CFQ) regarding the patient. We analysed the correlation, intraclass correlation, and self-proxy discrepancy between patients and caregivers on the CFQ over time. RESULTS One-hundred-and-nineteen cardiac arrest survivors (mean age = 60, 85 % male) and their caregivers were included. The CFQ scores of the patients and caregivers were equally low. The correlation (T1 r = 0.31; T2 r = 0.40; T3 r = 0.55) and intraclass correlation (T1 r = 0.48; T2 r = 0.56; T3 r = 0.71) between patient and caregiver increased over time. CONCLUSION This study does not support a lack of awareness of cognitive impairments by long-term cardiac arrest survivors. Future research may focus on alternative explanations for why patients have less cognitive complaints than expected based on the frequency of cognitive impairments. Possible explanations include a response shift.
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Affiliation(s)
- Pauline van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands.
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Simone Sep
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - Véronique Moulaert
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Jeannette Hofmeijer
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Jeanine Verbunt
- Adelante, Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, the Netherlands; Department of Rehabilitation Medicine, Maastricht University Medical Centre, Maastricht, the Netherland; CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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Hardeland C, Leonardsen ACL, Isern CB, Berge HM. Experiences of cardiac arrest survivors among young exercisers in Norway: A qualitative study. Resusc Plus 2022; 11:100293. [PMID: 36051158 PMCID: PMC9424599 DOI: 10.1016/j.resplu.2022.100293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 11/26/2022] Open
Abstract
Aim To explore how young exercisers experience surviving sudden cardiac arrest (SCA), focusing on interpretation of warning signs and experiences with the healthcare system. Methods The study had a qualitative design, and data was collected using individual, semi-structured interviews. Inclusion criteria were SCA survivors aged 18–50 years old who reported at least five hours of exercise/week prior to SCA, or who suffered SCA during or ≤60 min after exercise. Results 18 interviews were performed (4 females), age range 19–49 years old. Analysis identified the themes [1] neglected warning signs, [2] fluctuating between gratitude and criticism and [3] one size does not fit all. When young exercisers experienced symptoms such as fainting, chest pain, arrythmia, shortness of breath and fatigue, these were often ignored by either the participants, healthcare personnel or both. SCA survivors were grateful to the healthcare system and for the efforts made by healthcare personnel, but experienced a mismatch between what patients needed and could utilize, and what they actually received regarding both information and individualised services. Being young exercisers, the participants reported to have individual needs, but treatment and rehabilitation were not adapted and were mainly targeted to rehabilitation of older patients. Conclusion Patients and healthcare personnel should be aware of cardiac related symptoms and warning signs for SCA, and these should be properly assessed in the population of young exercisers. SCA survivors need useful and repeated information. The needs of SCA survivors among young exercisers require individualisation of services.
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Stripp TK, Wehberg S, Büssing A, Andersen-Ranberg K, Jensen LH, Henriksen F, Laursen CB, Søndergaard J, Hvidt NC. Protocol for EXICODE: the EXIstential health COhort DEnmark-a register and survey study of adult Danes. BMJ Open 2022; 12:e058257. [PMID: 35772823 PMCID: PMC9247662 DOI: 10.1136/bmjopen-2021-058257] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 05/05/2022] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION We established the EXIstential health COhort DEnmark (EXICODE) to examine how existential and spiritual needs, practices and orientations in a secular culture are linked to health outcomes, illness trajectory and overall cost of care in patients. Substantial literature demonstrates that existential and spiritual well-being has positive effects on health. While people turn to existential and spiritual orientations and practices during ageing, struggle with illness and approaching death, patients with severe illnesses like, for example, cancer similarly experience existential and spiritual needs. These needs are often unmet in secular societies leading to spiritual pain, unnecessary suffering, worse quality of life and higher medical costs of care. METHODS AND ANALYSIS EXICODE is a national cohort comprising a 10% random sample of the adult Danish population with individual-level register and survey data. Specific patient subgroups are oversampled to ensure diseased respondents. The questionnaire used in the survey consists of a collection of validated instruments on existential and spiritual constructs suited for secular culture as well as some ad hoc questions compiled in the comprehensive EXICODE Questionnaire. ETHICS AND DISSEMINATION The project is registered for legal and GDPR concerns by the University of Southern Denmark, journal number: 10.367. Ethical approval was not required by Danish law since EXICODE collects only interview, survey and register data, but due to institutional best-practice policy an ethical evaluation and approval were nevertheless obtained from the University of Southern Denmark Research Ethics Committee (institutional review board), journal number: 20/39546. The project follows The Danish Code of Conduct for Research Integrity and is carried out in accordance with the Helsinki Declaration. Results will be disseminated widely through publications in peer-reviewed scientific journals, international conferences, patient societies as well as mass and social media.
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Affiliation(s)
- Tobias Kvist Stripp
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Arndt Büssing
- Institute of Integrative Medicine, Witten/Herdecke University, Witten, Nordrhein-Westfalen, Germany
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Karen Andersen-Ranberg
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Danish Aging Research Center, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Lars Henrik Jensen
- Department of Oncology, Lillebaelt Hospital, Vejle, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Finn Henriksen
- Cardiology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Christian B Laursen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Research Unit at the Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
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Symptom Prevalence of Anxiety and Depression in Older Cardiac Arrest Survivors: A Comparative Nationwide Register Study. J Clin Med 2021; 10:jcm10184285. [PMID: 34575396 PMCID: PMC8470576 DOI: 10.3390/jcm10184285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/28/2021] [Accepted: 09/17/2021] [Indexed: 01/04/2023] Open
Abstract
Knowledge about psychological distress in older cardiac arrest (CA) survivors is sparse, and the lack of comparisons with general populations make it difficult to draw any strong conclusions about prevalence and potential changes caused by CA. Our aim was to compare psychological distress between older CA survivors and a general population. This study included survivors 65–80 years old and an age- and sex-matched general population. Data on survivors was collected from the Swedish Register of Cardiopulmonary Resuscitation. The Hospital Anxiety and Depression Scale was used to measure psychological distress. Data were analyzed with non-parametric statistics. The final sample included 1027 CA survivors and 1018 persons from the general population. In both groups, the mean age was 72 years (SD = 4) and 28% were women. The prevalence of anxiety was 9.9% for survivors and 9.5% for the general population, while the corresponding prevalence for depression was 11.3% and 11.5% respectively. Using the cut-off scores, no significant differences between the groups were detected. However, CA survivors reported significantly lower symptom levels using the subscale scores (ΔMdn = 1, p < 0.001). In conclusion, the CA survivors did not report higher symptom levels of anxiety and depression than the general population. However, since psychological distress is related to poor quality-of-life and recovery, screening for psychological distress remains important.
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Hellström P, Årestedt K, Israelsson J. A comprehensive description of self-reported health and life satisfaction in cardiac arrest survivors. Scand J Trauma Resusc Emerg Med 2021; 29:122. [PMID: 34419126 PMCID: PMC8380367 DOI: 10.1186/s13049-021-00928-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/22/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Self-reported health and life satisfaction are considered important outcomes in people surviving cardiac arrest. However, most previous studies have reported limited aspects on health, often based on composite scores, and few studies have focused on life satisfaction. Investigating health aspects with a broad and detailed perspective is important to increase the knowledge of life after cardiac arrest from the perspective of survivors. In addition, the knowledge of potential differences in health among survivors related to place of arrest (in-hospital cardiac arrest; IHCA or out-of-hospital cardiac arrest; OHCA) is scarce. The aim was to describe and compare self-reported health and life satisfaction in IHCA and OHCA survivors. METHODS: This observational cross-sectional study included adult cardiac arrest survivors six months after resuscitation, treated at five Swedish hospitals between 2013 and 2018. Participants received a study specific questionnaire including Health Index (HI), EQ-5D 5 Levels (EQ-5D-5L), Minimal Insomnia Sleeping Scale (MISS), Multidimensional Scale of Perceived Social Support (MSPSS), Hospital Anxiety and Depression Scale (HADS), and Satisfaction With Life Scale (SWLS). In order to present characteristics descriptive statistics were applied. The Mann-Whitney U test, chi-square test or Fishers' exact test were used to compare differences in self-reported health and life satisfaction between in-hospital- and out-of-hospital cardiac arrest survivors RESULTS: In total, 212 survivors participated. Based on scale scores and general measures, the median scores of health and life satisfaction among survivors were high: HI total = 29, EQ VAS = 80, and SWLS = 20. According to HI, most problems were reported for tiredness (37.3 %) and strength (26.4 %), while pain/discomfort (57.5 %) and anxiety/depression (42.5 %) where most common according to EQ-5D-5L. Except for EQ-5D-5L mobility (p = 0.023), MSPSS significant other (p = 0.036), and MSPSS family (p = 0.043), no health differences in relation to place of arrest were identified. CONCLUSIONS Although general health and life satisfaction were good among cardiac arrest survivors, several prevalent health problems were reported regardless of place of arrest. To achieve an improved understanding of health in cardiac arrest survivors, it is important to assess specific symptoms as a complement to composite scores of general, physical, emotional, and social health.
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Affiliation(s)
- Patrik Hellström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Johan Israelsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Region Kalmar County, Kalmar, Sweden
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Moving beyond survival and navigating survivorship: Mind the gaps! Resuscitation 2021; 167:395-397. [PMID: 34371145 DOI: 10.1016/j.resuscitation.2021.07.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 01/27/2023]
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Case R, Stub D, Mazzagatti E, Pryor H, Mion M, Ball J, Cartledge S, Keeble TR, Bray JE, Smith K. The second year of a second chance: Long-term psychosocial outcomes of cardiac arrest survivors and their family. Resuscitation 2021; 167:274-281. [PMID: 34242735 DOI: 10.1016/j.resuscitation.2021.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/12/2022]
Abstract
AIM Cardiac arrest (CA) survival has diverse psychosocial outcomes for both survivors and their close family, with little known regarding long-term adjustment and recovery experiences. We explored the psychological adjustment and experiential perspectives of survivors and families in the second year after out-of-hospital cardiac arrest (OHCA). METHODS A prospective, mixed-methods study of adult OHCA survivors in Victoria, Australia was conducted. Eighteen survivors and 12 family members completed semi-structured interviews 14-19 months post-arrest. Survivors' cognition, anxiety, depression and post-traumatic stress symptoms were measured using a battery of psychological assessments. A thematic content analysis approach was applied to qualitative interview data by two independent investigators, with data coded and categorised into themes and sub-themes. RESULTS Survivors' cognition, depression, anxiety and post-traumatic stress symptoms were not clinically elevated in the second year post-arrest. Subjective cognitive failures were associated with increased anxiety but not with mental state. Depression was significantly correlated with post-traumatic symptoms. Six primary themes emerged from survivors' recovery stories, focused on: awakening and realisation, barriers to adjustment, psychosocial difficulties, integration, protective factors and unmet needs. Family perspectives revealed four primary themes focused on trauma exposure, survivor adjustment problems, family impact, and areas for service improvement. CONCLUSION Survivors and their family members describe complex recovery journeys characterised by a range of psychosocial adjustment challenges, which are not adequately captured by common psychological measures. Post-arrest care systems are perceived by survivors and their families as inadequate due to a lack of accurate information regarding post-arrest sequalae, limited follow-up and inconsistent access to allied health care.
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Affiliation(s)
- Rosalind Case
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Ambulance Victoria, Melbourne, Australia; Florey Institute of Neuroscience and Mental Health, Melbourne, Australia.
| | - Dion Stub
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Ambulance Victoria, Melbourne, Australia
| | - Emilia Mazzagatti
- School of Psychological Sciences, Monash University, Melbourne, Australia
| | - Holly Pryor
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Marco Mion
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom
| | | | - Susie Cartledge
- Department of Cardiovascular Medicine, Alfred Health, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Thomas R Keeble
- The Essex Cardiothoracic Centre, Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, United Kingdom; School of Medicine, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
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Wagner MK, Kikkenborg Berg S, Hassager C, Joshi VL, Stenbæk DS, Missel M. Feeling understood for the first time: experiences of participation in rehabilitation after out-of-hospital sudden cardiac arrest. Eur J Cardiovasc Nurs 2021; 20:767-774. [PMID: 33993238 DOI: 10.1093/eurjcn/zvab002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/07/2020] [Accepted: 01/08/2021] [Indexed: 11/14/2022]
Abstract
AIMS Survivors of out-of-hospital sudden cardiac arrest (SCA) may suffer from long-term cognitive, psychological, or physical post-arrest consequences impacting and disrupting daily life. To adjust to and manage daily life is critical, and therefore a tailored rehabiliation programme was introduced to the participants. The study aimed to explore the lived experience among cardiac arrest survivors. METHODS AND RESULTS Data were gathered through six focus group interviews during a cardiac arrest rehabilitation programme. Thirty-three out-of-hospital SCA survivors (8 women and 25 men) participated. Time since cardiac arrest was on average 12-57 months. An exploratory qualitative design inspired by Ricoeur's phenomenological hermeneutics was applied. Two main themes emerged from the analysis and interpretation: (i) a lack of support from the health system in the transition from hospital to daily life; and (ii) feeling understood for the first time. The findings revealed that out-of-hospital SCA survivors experience a knowledge gap struggling for support. Attending the programme, gaining knowledge and experiencing peer support was described as a revelation for them. CONCLUSION The findings suggest that out-of-hospital SCA survivors felt understood for the first time when attending a cardiac arrest rehabilitation programme. A post-arrest pathway is needed led by a coordinating cardiac arrest specialist nursing service together with allied healthcare professionals. Focus on hypoxic brain injuries, emotional burdens, and supportive strategies are essential in the transition to daily life. Facilitated peer support is warranted.
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Affiliation(s)
- Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 33.5.18-21 DK-2200 Copenhagen N, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 33.5.18-21 DK-2200 Copenhagen N, Denmark
| | - Victoria Louise Joshi
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Southern Denmark University, Odense, Vestergade 17, DK-5800 Nyborg, Denmark
| | - Dea Siggaard Stenbæk
- Department of Neurology, Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6-8. DK-2100 Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen, Denmark
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11
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A narrative inquiry of survivors’ experiences of the time just before and after a cardiac arrest. Collegian 2021. [DOI: 10.1016/j.colegn.2020.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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12
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Wagner MK, Berg SK, Tang LH, Stenbaek DS, Hassager C, Missel M. Understanding the lived experiences of short- and long-term consequences on daily life after out-of-hospital cardiac arrest. A focus group study. J Adv Nurs 2020; 77:1442-1452. [PMID: 33314377 DOI: 10.1111/jan.14707] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/20/2020] [Accepted: 11/16/2020] [Indexed: 11/30/2022]
Abstract
AIM To explore and gain in-depth understanding of how out-of-hospital cardiac arrest survivors experience the short- and long-term consequences on daily life. DESIGN A qualitative exploratory design. METHODS A purposive sample of 32 survivors of out-of-hospital cardiac arrest. Data from six audiotaped focus group interviews were collected in either November 2018 or in March 2019. Analysis and interpretation of the transcribed texts was performed using a phenomenological-hermeneutic approach guided by Ricoeur for unfolding lived experiences. RESULTS Three narratives were identified. The survivors narrated how they in the early phase after the cardiac arrest experienced: (a) 'a fragmented memory at the mercy of the system'. The analysis further showed how the participants were: (b) 'living in the shadow of anxiety and mixed feelings' and with the: (c) 'lost sense of self' up to several years after survival. CONCLUSION The participants in our study experienced distinct bodily impairments, suffering, and the lost sense of self in the return to daily life from early on to several years after resuscitation. There seem to be an urgent need for an early initiated post-arrest transitional care program led by an expert cardiac arrest nurse. In particular, the healthcare professionals need to pay attention to survivors in employment and with children living at home. Facilitated cardiac arrest peer support groups might minimize the long-term suffering, heighten the self-image, and install a new hope for the future. IMPACT To ease the post-arrest return to daily life for out-of-hospital cardiac arrest survivors it seems important that a transitional care program from the inhospital setting to the community consist of: (a) screening for and education on bodily losses at an early stage, (b) provision of support on the often prolonged emotional reactions, and (c) referring for further individual and targeted psychological and neurological follow-up and rehabilitation if needed.
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Affiliation(s)
- Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Southern Denmark University, Nyborg, Denmark
| | - Selina K Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars H Tang
- Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Southern Denmark University, Nyborg, Denmark
| | - Dea S Stenbaek
- Neurobiology Research Unit, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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13
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Jensen AN, Bonnén KB, Kristiansen M. "We don't talk about his heart": Narrative sense-making and long-term readjustment among older out-of-hospital cardiac arrest survivors and their spouses. Resusc Plus 2020; 3:100024. [PMID: 34223307 PMCID: PMC8244505 DOI: 10.1016/j.resplu.2020.100024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 07/16/2020] [Accepted: 08/11/2020] [Indexed: 01/10/2023] Open
Abstract
Aim of the study Globally, there has been an increase in the survival rate and the average age of survivors from out-of-hospital cardiac arrest (OHCA). However, little is known about the joint OHCA-associated experiences among older survivors and their spouses in a long-term perspective. The aim of this study was to explore how narrative sense-making processes following OHCA shapes everyday life in a long-term perspective among older survivors and their spouses. Methods Five older male survivors and their female spouses were interviewed individually using narrative methods. Arthur Frank’s theory on illness narratives informed the analysis. Participant observation at two meetings for survivors and relatives regarding cardiac arrest was used for qualification of the interview guide. Results Five married couples participated. The mean age of the survivors and spouses was 70,4 and 71,4 years respectively, and time since OHCA varied from 12 to 66 months. Two themes of the dyadic experience emerged: 1) experiences during OHCA, and 2) experiences in life following OHCA. Subthemes differed with survivors emphasising a desire to return to the same life as before the OHCA, and the spouses narrating feelings of anxiety. Potential complications of the OHCA were often explained with reference to ageing processes, and the OHCA was contextualised in relation to previous life-changing events. Conclusion In a long-term perspective, OHCA shapes the life trajectory of both the survivor and the spouse, and the relationship between them, underscoring a need for patient-centred care with a greater focus on the relationship of the dyads. Unmet needs among survivors and spouses should be addressed by follow-up dialogue. Life after OHCA is embedded in the context of age and biography. A narrative approach in encounters could strengthen the support for couples. Survivors and spouses’ experiences contrasted pointing towards individual needs.
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Affiliation(s)
- Andrea Nedergaard Jensen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Katrine Bruun Bonnén
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging & Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Oster Farimagsgade 5, 1014, Copenhagen K, Denmark
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14
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Aristidou M, Vouzavali F, Karanikola MN, Lambrinou E, Papathanassoglou E. A Meta-ethnography of Out-of-Hospital Cardiac Arrest Survivors' Meanings on Life and Death. J Cardiovasc Nurs 2019; 33:E10-E20. [PMID: 29634649 DOI: 10.1097/jcn.0000000000000467] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Although out-of-hospital cardiac arrest (OHCA) survivors' physiological outcomes have been addressed, less is known on the holistic needs of individuals after OHCA, which hinders our ability to prioritize care around what really matters to survivors. AIM The aim of this study was to interpretatively synthesize qualitative findings on OHCA survivors' perceptions and meanings of life and death and existential issues. METHODS We used a meta-ethnographic synthesis of published qualitative studies addressing the experiences of OHCA survivors based on a systematic literature search (CINAHL, PsycINFO, Scopus, PubMed). Studies were selected based on predefined inclusion/exclusion criteria. The identified studies were subjected to a quality appraisal based on the Critical Appraisal Skills Programme. RESULTS Based on eligibility criteria, 6 phenomenological studies were included, of overall medium to high quality. One core theme, "the reality of death," and 4 main themes were identified: "redefining existence"; "revaluing death"; "being familiar with, yet oblivious of death"; and "living consciously." Emerging from the realization of death, the themes appeared to describe a gradual progression toward living consciously. CONCLUSIONS An existential trajectory and a need for meaning are central in the experience of OHCA survivors. When existential issues are not addressed, the ongoing suffering may interfere with survivors' recovery and quality of life. Future research needs to address specific needs and ways to support survivors' meaning-making.
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Affiliation(s)
- Maria Aristidou
- Maria Aristidou, MSc, RN Doctoral Candidate, Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, and Special Scientist, Department of Nursing, School of Health Sciences, European University of Cyprus. Fotini Vouzavali, PhD, MSc, RN High School Teacher, Vocational High School of Nurse Assistants, and Laboratory Instructor, Department of Nursing, Technological Educational Institute of Athens, Greece. Maria N. Karanikola, PhD, MSc, RN Assistant Professor, Department of Nursing, Cyprus University of Technology, Limassol. Ekaterini Lambrinou, PhD, MSc, RN Associate Professor, Department of Nursing, Cyprus University of Technology, Limassol. Elizabeth Papathanassoglou, PhD, MSc, RN Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Canada
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15
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Haydon G, van der Riet P, Inder K. Long-term survivors of cardiac arrest: A narrative inquiry. Eur J Cardiovasc Nurs 2019; 18:458-464. [DOI: 10.1177/1474515119844717] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Despite extensive knowledge and research in cardiac health there is limited understanding in how a cardiac arrest influences the life of long-term survivors. Objective: The aim of this study was to explore how long-term survivors of a cardiac arrest adjusted to their new reality, expressed in their re-storied narratives. Methods: Seven individuals surviving a cardiac arrest 5–26 years ago were interviewed through in-depth conversations over a six-month period. These interviews were analysed using Clandinin and Connelly’s framework of narrative inquiry. Results: Seven threads were found: Disbelief, Surveillance of their body, Loss of control and desire for normality, Keeping fit and informing others, Gratefulness, Spirituality – luck and fate, and Fragility of life and dying. Conclusions: All seven long-term survivors of cardiac arrest expressed a positive attitude. Despite the nature of the cardiac arrest and the hurdles that followed, they have a heightened appreciation for life. This indicates that after the adaptation to their new reality of being a cardiac arrest survivor life returns to a new normality.
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Affiliation(s)
| | | | - Kerry Inder
- University of Newcastle, Port Macquarie, Australia
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16
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Bremer A, Dahné T, Stureson L, Årestedt K, Thylén I. Lived experiences of surviving in‐hospital cardiac arrest. Scand J Caring Sci 2018; 33:156-164. [DOI: 10.1111/scs.12616] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 08/02/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Anders Bremer
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- Division of Emergency Medical Services Kalmar County Council Kalmar Sweden
| | - Tova Dahné
- Department of Surgical Sciences Anaesthesiology and Intensive Care Akademiska Hospital Uppsala University Uppsala Sweden
- Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Lovisa Stureson
- Department of Anaesthesiology and Intensive Care, and Department of Medical and Health Sciences Linköping University Linköping Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences Linnaeus University Kalmar/Växjö Sweden
- The Research Section Kalmar County Council Kalmar Sweden
| | - Ingela Thylén
- Departments of Cardiology and Medical and Health Sciences Linköping University Linköping Sweden
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17
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Sawyer KN, Elmer J. Measuring and improving outcomes that matter to patients after cardiac arrest. Resuscitation 2018; 125:A1-A2. [PMID: 29408662 DOI: 10.1016/j.resuscitation.2018.01.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 01/31/2018] [Indexed: 10/18/2022]
Affiliation(s)
- Kelly N Sawyer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
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