Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest: The Hanox Study

Abstract

Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) are poorly known. What are the month (M) 18 outcomes of survivors of out-of-hospital cardiac arrest (OHCA) who awakened during the first 2weeks' post-OHCA and their poor-outcome risk factors? All OHCA survivors with a Glasgow Coma Scale score≥12 during the first 2weeks' 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). 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 > 3days after cardiac arrest, and mechanical ventilation on days 3 and 7 were associated with poor functional outcome. Among patients who awoke (Glasgow Coma Scale score≥12) in the 14days 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. ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.