Long-Term Disabilities of Survivors of Out-of-Hospital Cardiac Arrest: The Hanox Study.
cardiac arrest
disability
prognosis
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
01
03
2020
revised:
03
07
2020
accepted:
10
07
2020
pubmed:
24
7
2020
medline:
14
9
2021
entrez:
24
7
2020
Statut:
ppublish
Résumé
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 2 weeks' post-OHCA and their poor-outcome risk factors? 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). 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. 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. ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.
Sections du résumé
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.
CLINICAL TRIAL REGISTRATION
ClinicalTrials.gov; No.: NCT02292147; URL: www.clinicaltrials.gov.
Identifiants
pubmed: 32702410
pii: S0012-3692(20)31951-6
doi: 10.1016/j.chest.2020.07.022
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT02292147']
Types de publication
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
699-711Investigateurs
Guillaume Hékimian
(G)
Nicolas Bréchot
(N)
Mathieu Schmidt
(M)
Alain Combes
(A)
Charles-Edouard Luyt
(CE)
Alexandre Demoule
(A)
Martin Dres
(M)
Julien Mayaux
(J)
Anne Peskine
(A)
Hélène Robert
(H)
Pascale Pradat-Diehl
(P)
Eléonore Bayen
(E)
Vincent Navarro
(V)
Damien Galanaud
(D)
Nathalie Marin
(N)
Julien Charpentier
(J)
Alain Cariou
(A)
Jean-Paul Mira
(JP)
Olivier Vignaud
(O)
Emmanuel Guérot
(E)
Jean-Luc Diehl
(JL)
Jean-Yves Fagon
(JY)
Nicolas Deye
(N)
Bruno Mégarbane
(B)
Jean-Pierre Guichard
(JP)
Nathalie Kubis
(N)
Alain Yelnik
(A)
Romain Sonneville
(R)
Lila Bouadma
(L)
Jean-François Timsit
(JF)
Isabelle Klein
(I)
Tarek Sharshar
(T)
Philippe Azouvi
(P)
Robert Carlier
(R)
Florence Colle
(F)
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.