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Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest

2020; Elsevier BV; Volume: 159; Issue: 2 Linguagem: Inglês

10.1016/j.chest.2020.07.022

1931-3543

A. Peskine, Alain Cariou, David Hajage, Nicolas Deye, Emmanuel Guérot, Martin Dres, Romain Sonneville, Alexandre Lafourcade, Vincent Navarro, Hélène Robert, Philippe Azouvi, Tarek Sharshar, É. Bayen, Charles‐Édouard Luyt, Guillaume Hékimian, Nicolas Bréchot, Mathieu Schmidt, Alain Combes, Charles‐Édouard Luyt, Alexandre Demoule, Martin Dres, Julien Mayaux, A. Peskine, Hélène Robert, P. Pradat-Diehl, É. Bayen, Vincent Navarro, Damien Galanaud, Nathalie Marin, Julien Charpentier, Alain Cariou, Jean‐Paul Mira, Olivier Vignaud, Emmanuel Guérot, Jean‐Luc Diehl, Jean-Yves Fagon, Nicolas Deye, Bruno Mégarbane, Jean‐Pierre Guichard, Nathalie Kubis, A. Yelnik, Romain Sonneville, Lila Bouadma, Jean‐François Timsit, Isabelle Klein, Tarek Sharshar, Philippe Azouvi, Robert Carlier, F. Colle,

Intensive Care Unit Cognitive Disorders

Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known.What are the month (M) 18 outcomes of survivors of out-of-hospital cardiac arrest (OHCA) who awakened during the first 2 weeks' post-OHCA and their poor-outcome risk factors?All OHCA survivors with a Glasgow Coma Scale score ≥12 during the first 2 weeks' post-OHCA were enrolled in six ICUs and followed up at M3, M6, M12, and M18. The primary outcome measure was Glasgow Outcome Scale-Extended (GOS-E) score at M18. Secondary outcome measures included evaluation at M18 of neurologic, behavioral, and cognitive disabilities; health-related quality of life (HR-QOL), anxiety and depression; and poor-outcome risk factors (GOS-E score ≤ 6).Among the 139 included patients, 98 were assessable for the primary outcome measure. At M18, 64 (65%) had full recovery or minor disabilities (GOS-E score > 6), 18 (18%) had moderate disabilities but were autonomous for daily-life activities (GOS-E score = 6), 12 (12%) had poor autonomy (GOS-E score < 6 but > 1), and four had died. Percentages of patients with GOS-E scores > 6 increased significantly over the 18-month study period. At M18, no patients had major neurologic disabilities, 20% had cognitive disabilities, 32% had anxiety symptoms, 25% had depression symptoms, and their HR-QOL was impaired compared with a sex- and age-matched population. Low-flow time, Sequential Organ Failure Assessment score at admission, coma duration > 3 days after cardiac arrest, and mechanical ventilation on days 3 and 7 were associated with poor functional outcome.Among patients who awoke (Glasgow Coma Scale score ≥12) in the 14 days following OHCA, 35% had moderate to severe disabilities or had died at M18. Interestingly, patients improved until M18 post-OHCA. Risk factors associated with poor functional outcome were low-flow time, clinical severity at ICU admission, prolonged coma duration, and mechanical ventilation.ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.