BACKGROUND: Little is known about long-term outcomes of patients who survive inhospital cardiac arrest. METHODS: We examined long-term survival after inhospital cardiac arrest and whether procedural changes that improved survival to discharge impacted long-term survival. Consecutive inhospital arrests in the Atlanta Veterans Affairs Medical Center (Atlanta, GA) from 1995 to 2004 (n = 732) were retrospectively analyzed. Data regarding the arrest was obtained, including age, left ventricular ejection fraction, medications, and comorbidities, presenting rhythm, location of arrest, code duration, and outcomes. Long-term mortality data was obtained based on chart and Social Security Death Index reviews. Further data was gathered on internal cardioverter-defibrillator presence and use in survivors. RESULTS: Overall, 49 subjects (6.6%) survived to discharge. Univariate analysis found that ventricular tachycardia/ventricular fibrillation and the use of beta-blockers, angiotensin-converting enzyme inhibitors, and antiarrhythmics at the time of arrest were associated with increased survival, whereas advancing age and comorbidities were associated with a higher risk of mortality. Multivariate analysis determined that age, rhythm, and comorbidities independently affected survival. Implementation of a resuscitation program previously documented to improve survival to discharge did not translate to durable long-term survival. Three-year survival rate after discharge was only 41%. Alternatively, subjects with internal cardioverter-defibrillator showed a 36% improvement in 3-year survival rate to 77% (P = .001). CONCLUSIONS: Subjects with inhospital cardiac arrest have poor long-term prognoses. A strategy that improved inhospital survival did not alter long-term mortality rate. Thus, survival to discharge may not be a sufficient end point for future resuscitation trials.
BACKGROUND: Little is known about long-term outcomes of patients who survive inhospital cardiac arrest. METHODS: We examined long-term survival after inhospital cardiac arrest and whether procedural changes that improved survival to discharge impacted long-term survival. Consecutive inhospital arrests in the Atlanta Veterans Affairs Medical Center (Atlanta, GA) from 1995 to 2004 (n = 732) were retrospectively analyzed. Data regarding the arrest was obtained, including age, left ventricular ejection fraction, medications, and comorbidities, presenting rhythm, location of arrest, code duration, and outcomes. Long-term mortality data was obtained based on chart and Social Security Death Index reviews. Further data was gathered on internal cardioverter-defibrillator presence and use in survivors. RESULTS: Overall, 49 subjects (6.6%) survived to discharge. Univariate analysis found that ventricular tachycardia/ventricular fibrillation and the use of beta-blockers, angiotensin-converting enzyme inhibitors, and antiarrhythmics at the time of arrest were associated with increased survival, whereas advancing age and comorbidities were associated with a higher risk of mortality. Multivariate analysis determined that age, rhythm, and comorbidities independently affected survival. Implementation of a resuscitation program previously documented to improve survival to discharge did not translate to durable long-term survival. Three-year survival rate after discharge was only 41%. Alternatively, subjects with internal cardioverter-defibrillator showed a 36% improvement in 3-year survival rate to 77% (P = .001). CONCLUSIONS: Subjects with inhospital cardiac arrest have poor long-term prognoses. A strategy that improved inhospital survival did not alter long-term mortality rate. Thus, survival to discharge may not be a sufficient end point for future resuscitation trials.
Authors: T Jared Bunch; Roger D White; Bernard J Gersh; Ryan A Meverden; David O Hodge; Karla V Ballman; Stephen C Hammill; Win-Kuang Shen; Douglas L Packer Journal: N Engl J Med Date: 2003-06-26 Impact factor: 91.245
Authors: Douglas P Zipes; A John Camm; Martin Borggrefe; Alfred E Buxton; Bernard Chaitman; Martin Fromer; Gabriel Gregoratos; George Klein; Arthur J Moss; Robert J Myerburg; Silvia G Priori; Miguel A Quinones; Dan M Roden; Michael J Silka; Cynthia Tracy; Sidney C Smith; Alice K Jacobs; Cynthia D Adams; Elliott M Antman; Jeffrey L Anderson; Sharon A Hunt; Jonathan L Halperin; Rick Nishimura; Joseph P Ornato; Richard L Page; Barbara Riegel; Silvia G Priori; Jean-Jacques Blanc; Andrzej Budaj; A John Camm; Veronica Dean; Jaap W Deckers; Catherine Despres; Kenneth Dickstein; John Lekakis; Keith McGregor; Marco Metra; Joao Morais; Ady Osterspey; Juan Luis Tamargo; José Luis Zamorano Journal: J Am Coll Cardiol Date: 2006-09-05 Impact factor: 24.094
Authors: Arthur J Moss; Wojciech Zareba; W Jackson Hall; Helmut Klein; David J Wilber; David S Cannom; James P Daubert; Steven L Higgins; Mary W Brown; Mark L Andrews Journal: N Engl J Med Date: 2002-03-19 Impact factor: 91.245
Authors: S J Connolly; M Gent; R S Roberts; P Dorian; D Roy; R S Sheldon; L B Mitchell; M S Green; G J Klein; B O'Brien Journal: Circulation Date: 2000-03-21 Impact factor: 29.690
Authors: A C Cohn; W M Wilson; B Yan; S B Joshi; M Heily; P Morley; P Maruff; L E Grigg; A E Ajani Journal: Intern Med J Date: 2004-07 Impact factor: 2.048
Authors: Thomas H Sanderson; Christian A Reynolds; Rita Kumar; Karin Przyklenk; Maik Hüttemann Journal: Mol Neurobiol Date: 2012-09-26 Impact factor: 5.590
Authors: Paul S Chan; Brahmajee K Nallamothu; Harlan M Krumholz; John A Spertus; Yan Li; Bradley G Hammill; Lesley H Curtis Journal: N Engl J Med Date: 2013-03-14 Impact factor: 91.245
Authors: Paul Feingold; Michael J Mina; Rachel M Burke; Barry Hashimoto; Sara Gregg; Greg S Martin; Kenneth Leeper; Timothy Buchman Journal: Resuscitation Date: 2015-12-17 Impact factor: 5.262
Authors: Cindy H Hsu; Jiaqi Li; Marisa J Cinousis; Kelsey R Sheak; David F Gaieski; Benjamin S Abella; Marion Leary Journal: Crit Care Med Date: 2014-12 Impact factor: 7.598