Quality of Survival After In-Hospital CPR
ABSTRACT & COMMENTARY
Synopsis: Most patients who survive an episode of in-hospital cardiopulmonary resuscitation and are discharged from the hospital are able to live independently and to return to a satisfactory quality of life.
Source: de Vos R, et al. Arch Intern Med 1999; 159:249-254.
In this study from a 1000-bed teaching hospital in the Netherlands, the outcomes of inpatients who underwent cardiopulmonary resuscitation (CPR) during a seven-year period were determined. Survivors were assessed for quality of life using measures of physical, psychological, and social functioning, including the 136-item self-reporting Sickness Impact Profile (SIP).
Of the 827 patients who underwent CPR during the study period, 385 initially survived and 162 (20%) were discharged alive from the hospital. Follow-up data were unobtainable for only 10 patients. Fifty-one patients had died, 29 within the first six months after discharge. Of the remaining 101 survivors (12% of the total group), 90 (89%, 50 men, mean age 64 years) participated in the interview and form the basis of de Vos and colleagues’ results. Mean time from CPR to interview was 15 months (range, 3-72 months).
On average, the survivors rated their own quality of life as 7 on a scale of 10. Most of them (74%) were independent in daily life; 12 survivors (13%) had restrictions in daily life but were able to look after themselves, and 12 (13%) were either partially or totally dependent. Seventeen percent were cognitively impaired and 16% had symptoms of depression. Multivariate analysis showed that quality of life and cognitive function were determined by two factors—the reason for admission and age—readily available prior to CPR. Patients older than age 70 and those who were not independent prior to admission were more likely to die during follow-up. However, factors during and shortly after CPR, such as prolonged cardiac arrest and initial coma, were not significant determinants of either quality of life or cognitive functioning among survivors. Quality of life among the CPR survivors in this study was not as good as that of a reference group of elderly persons, but was better than that of a reference group of patients with strokes.
COMMENT BY DAVID J. PIERSON, MD
The results of this study are encouraging. They demonstrate that, although in-hospital CPR is frequently unsuccessful, patients who survive to hospital discharge tend to have a relatively good subsequent quality of life. Only five patients among the 827 in the total cohort were discharged from the hospital in a vegetative state, and four of these died within three months. Both the likelihood of survival and subsequent quality of life are influenced by the patient’s age and underlying state of health. Thus, these findings, as well as those from similar studies, may enable clinicians and patients to make better decisions in the future about the advisability of CPR should cardiac arrest occur in the hospital. For patients who are successfully resuscitated, the outlook may be better than we have come to expect.
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