Out-of-Hospital cardiac arrest survivors: Long-Term survival and resource utilization

Abstract

Study objectives: We determine long-term survival rates, functional status, and predictors of implantable cardiac defibrillator (ICD) use for patients who survive to discharge after out-of-hospital cardiac arrest. Methods: This was a retrospective cohort study of out-of-hospital cardiac arrest survivors transported to 2 large suburban community hospitals between January 1993 and December 2002. Data were abstracted from emergency medical services and hospital records about arrest characteristics, including arrest etiology, functional status at discharge using cerebral performance categories (CPC), and 1- and 3-year survival rates. We collated data about hospital interventions, including coronary angiography, echocardiography, electrophysiology studies, and ICD placement. We compared rates or procedures performed before or after January 1, 1998, to assess temporal trends in ICD therapy. Results: There were 112 survivors. They were predominantly men (64.8%), a witnessed arrest (75.9%), and sustained a ventricular tachycardia/ventricular fibrillation (VT/VF) arrest (91.2%). The most common etiologies of arrest were acute myocardial infarction (AMI) (50.5%) or primary VT/VF (27.2%). The majority (83.7%) of patients were discharged with good neurologic function (CPC 1 or 2). Of all patients with known outcomes, 90 (90.0%) were alive at 1 year, and 72 (92.3%) were alive at 3 years. Patients who received an ICD were older (67.4 versus 60.7 years, P=.25), sustained a primary VT/VF arrest (versus AMI VT/VF; 92.0% versus 30.8%, P<.001), and tended toward ICD placement if they had severe left ventricular dysfunction (66.7% versus 44.6%, P=.13). There was no significant difference in the overall rate of ICD placement (54.4% versus 45.2%, P=.43) between pre- and post-1998 periods. Conclusion: Cardiac arrest survivors have good long-term survival and neurologic function. Most patients with a primary VT/VF arrest receive ICD placement. We found no temporal difference in the rate of ICD placement in this cohort. Study objectives: We determine long-term survival rates, functional status, and predictors of implantable cardiac defibrillator (ICD) use for patients who survive to discharge after out-of-hospital cardiac arrest. Methods: This was a retrospective cohort study of out-of-hospital cardiac arrest survivors transported to 2 large suburban community hospitals between January 1993 and December 2002. Data were abstracted from emergency medical services and hospital records about arrest characteristics, including arrest etiology, functional status at discharge using cerebral performance categories (CPC), and 1- and 3-year survival rates. We collated data about hospital interventions, including coronary angiography, echocardiography, electrophysiology studies, and ICD placement. We compared rates or procedures performed before or after January 1, 1998, to assess temporal trends in ICD therapy. Results: There were 112 survivors. They were predominantly men (64.8%), a witnessed arrest (75.9%), and sustained a ventricular tachycardia/ventricular fibrillation (VT/VF) arrest (91.2%). The most common etiologies of arrest were acute myocardial infarction (AMI) (50.5%) or primary VT/VF (27.2%). The majority (83.7%) of patients were discharged with good neurologic function (CPC 1 or 2). Of all patients with known outcomes, 90 (90.0%) were alive at 1 year, and 72 (92.3%) were alive at 3 years. Patients who received an ICD were older (67.4 versus 60.7 years, P=.25), sustained a primary VT/VF arrest (versus AMI VT/VF; 92.0% versus 30.8%, P<.001), and tended toward ICD placement if they had severe left ventricular dysfunction (66.7% versus 44.6%, P=.13). There was no significant difference in the overall rate of ICD placement (54.4% versus 45.2%, P=.43) between pre- and post-1998 periods. Conclusion: Cardiac arrest survivors have good long-term survival and neurologic function. Most patients with a primary VT/VF arrest receive ICD placement. We found no temporal difference in the rate of ICD placement in this cohort.