Resuscitation 85 (2014) 538–543
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Clinical paper
Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months夽 Ewa Wallin a,∗ , Ing-Marie Larsson a , Sten Rubertsson a , Marja-Leena Kristofferzon b,c a b c
Department of Surgical Sciences-Anaesthesiology & Intensive Care, Uppsala University, SE- 751 85 Uppsala, Sweden Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Sweden Department of Public Health and Caring Sciences, Uppsala University, Sweden
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Article history: Received 11 June 2013 Received in revised form 12 November 2013 Accepted 9 December 2013 Keywords: Cardiac arrest Hypothermia treatment Intensive care Neurological outcome Cognitive function Life satisfaction
a b s t r a c t Aim of the study: To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors’ life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with “life as a whole” was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients’ functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients’ function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan. © 2013 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Return of spontaneous circulation (ROSC) is frequently followed by a post-resuscitation syndrome that may entail secondary neurological damages and other organ dysfunction.1,2 The severity of brain damage after cardiac arrest (CA) is influenced by several factors such as the length of the interruption of cerebral blood flow, the duration, and quality of resuscitation interventions as well as the patient’s age and the cause of the CA, all of which affect survival rate.3 Therapeutic hypothermia treatment (TH) (33 ◦ C ± 1) maintained for a period of 12–24 h post-CA has proven useful, thus to improving the neurological outcome and reducing mortality following CA.4,5 The purpose of resuscitation and subsequent
夽 A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.12.020. ∗ Corresponding author. Tel.: +46 18 6114840; fax: +46 18 507845. E-mail address: [email protected] (E. Wallin). 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.12.020
hypothermia treatment is to regain the patient’s pre-CA health status. Life after CA survival is affected by and has been described as including severe fatigue, feelings of anxiety and/or depression, increased dependency in activities of daily life (ADL) and decreased QoL.6–9 Studies describing patients’ cognitive function, ADL, and life satisfaction after CA have measured physical and mental QoL and shown that cognitive complaints exist but do not always affect QoL, ADL or the ability to return to work.9–13 The majority of the previous studies have been cross-sectional and measurements have been performed between 3 months and 2 years post-CA. The aim of the present study was to describe differences over time regarding functional outcome using cerebral performance category (CPC) at discharge from the ICU and at 1 and 6 months after CA in cases where TH was used in postresuscitation care. Additional aims were to describe differences in ADL and cognitive function within 1 and 6 months postCA, life satisfaction 6 months after CA and possible gender differences.
E. Wallin et al. / Resuscitation 85 (2014) 538–543
2. Material and methods 2.1. Inclusion criteria for TH This prospective observational study was part of a project performed at three intensive care units in Sweden between May, 2008 and May, 2012 and focused on survivors of CA. Eligible for inclusion were patients still comatose with a glasgow coma scale (GCS)14 3 after successful ROSC, with a systolic arterial blood pressure ≥ 80 mmHg > 5 min, regardless of whether the CA occurred in or out of hospital, or initial to the ECG rhythm. Patients with suspected pregnancy, terminal illness and/or primary deranged coagulation, and age
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Clinical paper
Cardiac arrest and hypothermia treatment-function and life satisfaction among survivors in the first 6 months夽 Ewa Wallin a,∗ , Ing-Marie Larsson a , Sten Rubertsson a , Marja-Leena Kristofferzon b,c a b c
Department of Surgical Sciences-Anaesthesiology & Intensive Care, Uppsala University, SE- 751 85 Uppsala, Sweden Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Sweden Department of Public Health and Caring Sciences, Uppsala University, Sweden
a r t i c l e
i n f o
Article history: Received 11 June 2013 Received in revised form 12 November 2013 Accepted 9 December 2013 Keywords: Cardiac arrest Hypothermia treatment Intensive care Neurological outcome Cognitive function Life satisfaction
a b s t r a c t Aim of the study: To describe differences over time in outcome, physical and cognitive function among survivors of cardiac arrest treated with hypothermia and to examine survivors’ life satisfaction 6 months after cardiac arrest as well as gender differences. Methods: The study was prospective and included 45 cardiac arrest survivors admitted to three Swedish hospitals between 2008 and 2012. Participants were followed from intensive care unit discharge to one and six months after cardiac arrest. In addition to cerebral performance category (CPC), participants were asked to complete questionnaires regarding activities in daily life (Barthel index), cognitive function (mini mental state examination), and life satisfaction (LiSat-11). Results: Outcome measured using CPC scores improved over time. At 6 months, all participants were classified as having a good outcome. At one month, participants were impaired but improved over time in their activities in daily life and cognitive function. At 6 months satisfaction with “life as a whole” was seen in 70%. Conclusions: Cardiac arrest survivors are satisfied with life as a whole despite a severe illness that has impaired their physical and cognitive function, which seemed to improve over time. Predicting patients’ functional outcome in early stages is difficult, and the CPC score alone is not sufficient to assess patients’ function. It is a need to reach a consensus to which instruments best reflect physical and cognitive function as well as to specify a rehabilitation plan. © 2013 Elsevier Ireland Ltd. All rights reserved.
1. Introduction Return of spontaneous circulation (ROSC) is frequently followed by a post-resuscitation syndrome that may entail secondary neurological damages and other organ dysfunction.1,2 The severity of brain damage after cardiac arrest (CA) is influenced by several factors such as the length of the interruption of cerebral blood flow, the duration, and quality of resuscitation interventions as well as the patient’s age and the cause of the CA, all of which affect survival rate.3 Therapeutic hypothermia treatment (TH) (33 ◦ C ± 1) maintained for a period of 12–24 h post-CA has proven useful, thus to improving the neurological outcome and reducing mortality following CA.4,5 The purpose of resuscitation and subsequent
夽 A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.12.020. ∗ Corresponding author. Tel.: +46 18 6114840; fax: +46 18 507845. E-mail address: [email protected] (E. Wallin). 0300-9572/$ – see front matter © 2013 Elsevier Ireland Ltd. All rights reserved. http://dx.doi.org/10.1016/j.resuscitation.2013.12.020
hypothermia treatment is to regain the patient’s pre-CA health status. Life after CA survival is affected by and has been described as including severe fatigue, feelings of anxiety and/or depression, increased dependency in activities of daily life (ADL) and decreased QoL.6–9 Studies describing patients’ cognitive function, ADL, and life satisfaction after CA have measured physical and mental QoL and shown that cognitive complaints exist but do not always affect QoL, ADL or the ability to return to work.9–13 The majority of the previous studies have been cross-sectional and measurements have been performed between 3 months and 2 years post-CA. The aim of the present study was to describe differences over time regarding functional outcome using cerebral performance category (CPC) at discharge from the ICU and at 1 and 6 months after CA in cases where TH was used in postresuscitation care. Additional aims were to describe differences in ADL and cognitive function within 1 and 6 months postCA, life satisfaction 6 months after CA and possible gender differences.
E. Wallin et al. / Resuscitation 85 (2014) 538–543
2. Material and methods 2.1. Inclusion criteria for TH This prospective observational study was part of a project performed at three intensive care units in Sweden between May, 2008 and May, 2012 and focused on survivors of CA. Eligible for inclusion were patients still comatose with a glasgow coma scale (GCS)14 3 after successful ROSC, with a systolic arterial blood pressure ≥ 80 mmHg > 5 min, regardless of whether the CA occurred in or out of hospital, or initial to the ECG rhythm. Patients with suspected pregnancy, terminal illness and/or primary deranged coagulation, and age
