Long-term disabilities of survivors of out-of-hospital cardiac arrest: the Hanox study.

Abstract Background Long-term outcomes of awakened survivors of out-of-hospital cardiac arrest (OHCA) is 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 Glasgow coma score ≥12 during the first 2 weeks post-OHCA were enrolled in six ICUs and followed at M3, M6, M12 and M18. The primary outcome measure was Glasgow outcome scale-extended (GOS-E) at M18. Secondary outcome measures included evaluation of neurological, behavioral and cognitive disabilities, health-related quality of life (HR-QOL), anxiety and depression, and poor-outcome risk factors (GOS-E≤6) at M18. Results Among 139 included patients, 98 were assessable for the primary outcome measure. At M18, 64 (65%) had full recovery or minor disabilities (GOS-E>6), 18 (18%) had moderate disabilities but were autonomous for daily-life activities (GOS-E=6), 12 (12%) had poor autonomy (GOS-E 1) and 4 had died. Percentages of GOS-E>6 patients increased significantly over the 18-month study period. At M18, no patients had major neurological disabilities, 20% had cognitive disabilities, 32% had anxiety symptoms, 25% had depression symptoms, and their HR-QOL was impaired as compared to sex- and age-matched population. Low-flow time, Sequential Organ-Failure Assessment Score at admission, coma duration >3 days after CA or mechanical ventilation on days 3 and 7 were associated with poor functional outcome. Interpretation Among patients who awoke (GCS≥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.