Abstract 11652: Long-Term Outcomes in Post-Cardiac Arrest Patients With Severe Functional Disability at Hospital Discharge

Abstract

Background: In patients resuscitated from out of hospital cardiac arrest (OHCA) with severe functional disability, life support is often limited. However, long-term outcomes in such patients are largely unknown, leaving little data to guide this decision. Methods: We performed a retrospective cohort study of OHCA survivors ≥ 18 years of age, treated at a single center in Western Pennsylvania from 01/01/2010-05/20/2021, with a modified Rankin scale (mRS) of 5 and cerebral performance category (CPC) of 4 at hospital discharge. We recorded demographics, arrest characteristics, and neurological exam at hospital discharge. We reviewed records from index hospitalization to the present to determine the date and type of subsequent healthcare encounters and whether or not subjects followed commands in subsequent neurological exams. National Death Index query and internet search for obituary until 5/20/2021. Survival time and hazard ratios were estimated using Kaplan-Meier curves. Results: Among 2,460 OHCA patients treated, 857 (35%) survived to hospital discharge. Of survivors, 83 (9.6%) had mRS 5 and CPC 4, and 69 (85%) did not follow commands. One year mortality was 59% (n=48) with median survival time of 166 days (IQR 77-1083). Age ≥ 65 years was not associated with survival [HR 1.51, 95%CI 0.79 - 2.89]. We found 361 subsequent medical encounters (median per patient =1, IQR 0-4), most often ED visits (n=131, 41%). Visits comprised 87 (28%) well patient visit/medication refills, 60 (22%) infections, and 38 (12%) tracheostomy/feeding tube issues. Average frequency of healthcare encounters was about once every 3 months (.30 encounters per month, SD .799). Of subjects who did not follow commands at hospital discharge, 4 (6%) followed commands on subsequent encounters. Conclusions: About 10% of OHCA survivors were discharged from the hospital with severe functional disability. They had a 59% 1-year mortality and frequent visits to the ED. Few (6%) patients regained the ability to follow commands.