Graham Nichol1, Danielle Guffey2, Ian G Stiell3, Brian Leroux2, Sheldon Cheskes4, Ahamed Idris5, Peter J Kudenchuk6, Renee S Macphee7, Lynn Wittwer8, Jon C Rittenberger9, Thomas D Rea6, Kellie Sheehan2, Val E Rac10, Keitki Raina9, Kyle Gorman11, Tom Aufderheide12. 1. Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States; University of Washington-Harborview Center for Prehospital Emergency Care, Department of Medicine, University of Washington, Seattle, WA, United States. Electronic address: nichol@uw.edu. 2. Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, United States. 3. Department of Emergency Medicine, University of Ottawa, Ottawa Health Research Institute, Ottawa, ON, Canada. 4. Rescu, Li Ka Shing Knowledge Institute, St Michael's Hospital and Sunnybrook Center for Prehospital Medicine, Division of Emergency Medicine, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada. 5. Departments of Emergency Medicine and Internal Medicine, University of Texas Southwestern, Dallas, TX, United States. 6. King County EMS, Seattle and King County Public Health, and Department of Medicine, University of Washington, Seattle, WA, United States. 7. Wilfrid Laurier University, Waterloo, ON, Canada. 8. Clark County Emergency Medical Services, Vancouver, WA, United States. 9. Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, United States. 10. Toronto Health Economics and Technology Assessment Collaborative, Institute of Health Policy, Measurement and Evaluation, University of Toronto, Toronto, ON, Canada. 11. Clackamas Fire District #1, Clackamas, OR, United States. 12. Medical College of Wisconsin, Milwaukee, WI, United States.
Abstract
IMPORTANCE: Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE: We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. DESIGN: Prospective cohort sub-study of a randomized trial. SETTING: The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. PARTICIPANTS: Consenting survivors to discharge. MAIN OUTCOME MEASURES: Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). RESULTS: Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. CONCLUSIONS AND RELEVANCE: The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.
RCT Entities:
IMPORTANCE: Assessment of morbidity is an important component of evaluating interventions for patients with out-of-hospital cardiac arrest (OHCA). OBJECTIVE: We evaluated among survivors of OHCA cognition, functional status, health-related quality of life and depression as functions of patient and emergency medical services (EMS) factors. DESIGN: Prospective cohort sub-study of a randomized trial. SETTING: The parent trial studied two comparisons in persons with non-traumatic OHCA treated by EMS personnel participating in the Resuscitation Outcomes Consortium. PARTICIPANTS: Consenting survivors to discharge. MAIN OUTCOME MEASURES: Telephone assessments up to 6 months after discharge included neurologic function (modified Rankin score, MRS), cognitive impairment (Adult Lifestyle and Function Mini Mental Status Examination, ALFI-MMSE), health-related quality of life (Health Utilities Index Mark 3, HUI3) and depression (Telephone Geriatric Depression Scale, T-GDS). RESULTS: Of 15,794 patients enrolled in the parent trial, 729 (56% of survivors) consented. About 644 respondents (88% of consented) completed ≥ 1 assessment. Likelihood of assessment was associated with baseline characteristics and study site. Most respondents had MRS ≤ 3 (82.7%), no cognitive impairment (82.7% ALFI-MMSE ≥ 17), no severe impairment in health (71.6%, HUI3 ≥ 0.7) and no depression (90.1% T-GDS≤10). Outcomes did not differ by trial intervention or time from hospital discharge. CONCLUSIONS AND RELEVANCE: The majority of patients in this large cohort who survived cardiac arrest and were interviewed had no, mild or moderate health impairment. Concern about poor quality of life is not a valid reason to abandon efforts to improve an EMS system's response to cardiac arrest.
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