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Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest

Anne Peskine 1 Alain Cariou 2 David Hajage 3, 4, 5 Nicolas Deye 6 Emmanuel Guérot 7 Martin Dres 8 Romain Sonneville 9 Alexandre Lafourcade 3, 5, 4 Vincent Navarro 10 Hélène Robert 1 Philippe Azouvi 11 Tarek Sharshar 12 Eleonore Bayen 1 Charles-Edouard Luyt 13, 14 Guillaume Hékimian Nicolas Bréchot Mathieu Schmidt Alain Combes Alexandre Demoule Julien Mayaux Pascale Pradat-Diehl Damien Galanaud Nathalie Marin Julien Charpentier Jean-Paul Mira Olivier Vignaud Jean-Luc Diehl Jean-Yves Fagon Bruno Mégarbane Jean-Pierre Guichard Nathalie Kubis Alain Yelnik Lila Bouadma Jean-François Timsit Isabelle Klein Robert Carlier Florence Colle
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.
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Submitted on : Saturday, January 9, 2021 - 1:59:25 PM
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Anne Peskine, Alain Cariou, David Hajage, Nicolas Deye, Emmanuel Guérot, et al.. Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest. Chest, American College of Chest Physicians, 2020, ⟨10.1016/j.chest.2020.07.022⟩. ⟨hal-03104616⟩

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