Anne Peskine1, Alain Cariou2, David Hajage3, Nicolas Deye4, Emmanuel Guérot5, Martin Dres6, Romain Sonneville7, Alexandre Lafourcade3, Vincent Navarro8, Hélène Robert1, Philippe Azouvi9, Tarek Sharshar10, Eleonore Bayen1, Charles-Edouard Luyt11. 1. Service de Médecine Physique et Réadaptation, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France. 2. Service de Médecine Intensive Réanimation, Hôpital Cochin, APHP, Paris et Université de Paris, Faculté de Médecine, Paris, France. 3. Sorbonne Université, INSERM, Institut Pierre-Louis d'Epidémiologie et de Santé Publique, APHP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Département Biostatistique Santé Publique et Information Médicale, Centre de Pharmacoépidémiologie (Cephepi), Paris, France. 4. Service de Médecine Intensive Réanimation, Hôpital Lariboisière, APHP, Paris, France. 5. Service de Médecine Intensive Réanimation, Hôpital Européen Georges-Pompidou, APHP, Paris, France. 6. Service de Pneumologie et Médecine Intensive Réanimation (département R3S), Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. 7. Service de Médecine Intensive Réanimation, Hôpital Bichat-Claude-Bernard, APHP, Paris, France. 8. Sorbonne Université, ICM (Institut du Cerveau et de la Moelle Epinière), INSERM, CNRS, and Unité d'Épilepsie et d'EEG, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. 9. Service de Médecine Physique et Réadaptation, Hôpital Raymond-Poincaré, APHP, Garches, France. 10. Service de Réanimation Neurochirurgicale, Hôpital Sainte-Anne, Paris, France. 11. Sorbonne Université, INSERM, UMRS_1166-ICAN Institute of Cardiometabolism and Nutrition, and Service de Médecine Intensive Réanimation, Institut de Cardiologie, Groupe Hospitalier Pitié-Salpêtrière, APHP, Paris, France. Electronic address: charles-edouard.luyt@aphp.fr.
Abstract
BACKGROUND: Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known. RESEARCH QUESTION: 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? STUDY DESIGN AND METHODS: 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). RESULTS: 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. INTERPRETATION: 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.
BACKGROUND: Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known. RESEARCH QUESTION: 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? STUDY DESIGN AND METHODS: 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). RESULTS: 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. INTERPRETATION: 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. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.
Authors: Alessia Vincent; Katharina Beck; Emanuel Thommen; Madlaina Widmer; Christoph Becker; Nina Loretz; Sebastian Gross; Jonas Mueller; Simon A Amacher; Chantal Bohren; Rainer Schaefert; Jens Gaab; Stephan Marsch; Christian Emsden; Kai Tisljar; Raoul Sutter; Sabina Hunziker Journal: PLoS One Date: 2022-10-14 Impact factor: 3.752