Volume 17 Supplement 2

33rd International Symposium on Intensive Care and Emergency Medicine

Open Access

Cognitive performance and capacity to return home following out-of-hospital cardiac arrest

  • J Petrie1,
  • C Lockie1,
  • S Brett1 and
  • R Stümpfle1
Critical Care201317(Suppl 2):P305

DOI: 10.1186/cc12243

Published: 19 March 2013

Introduction

Before the introduction of primary percutaneous coronary intervention (PCI) and therapeutic hypothermia (TH) to out-of-hospital cardiac arrest (OOHCA) management, survival to hospital discharge with intact neurological function was poor [1, 2]. We aimed to quantify the survival and degree of neurological impairment in OOHCA patients admitted to our ICU since the adoption of post-OOHCA bundles.

Methods

Sixty-nine consecutive OOHCA patients admitted to the ICU at Hammersmith Hospital from 1 January 2011 to 30 June 2012 were identified and reviewed from hospital databases. Cognitive status was scored using Cerebral Performance Category (CPC); 1 to 2 normal-mild and 3 to 4 moderate-severe neurological impairment. Scores were determined from ICU summaries, occupational and physiotherapy reports. Hospital discharge outcomes were determined from hospital databases.

Results

TH was initiated in 93% (64/69) of OOHCA patients and 87% (40/46) with ischaemic cardiac aetiology underwent PCI. ICU survival was 58% (40/69); 65% (26/40) scoring CPC 1 to 2 and 35% (14/40) CPC 3 to 4 at ICU discharge. Two patients with CPC 2 improved to CPC 1 during their hospital stay. All patients with CPC 1 to 2 survived to hospital discharge; two required general rehabilitation before returning home. Only 43% (6/14) of CPC 3 to 4 patients survived to hospital discharge; none returned home. Two went into hospice care, one was repatriated to another hospital and three went to neuro-rehab. No CPC 3 to 4 patients improved CPC scores after ICU discharge. Overall hospital survival was 46%. See Table 1.
Table 1

Discharge and neurological status of OOHCA patients

  

Discharge

 

Hospital discharge destination

Score

ICU

Hospital

Home

Neuro-rehab

Repatriation

Hospice

CPC 1

20

22

19

0

3

0

CPC 2

6

4

4

0

0

0

CPC 3

4

3

0

3

0

0

CPC 4

10

3

0

0

1

2

Total

40

32

23

3

4

2

Conclusion

OOHCA patients admitted to our ICU had a 46% chance of surviving to hospital discharge. Most patients left hospital with good neurological status (CPC 1 to 2); moderate-severe neurological disability (CPC 3 to 4) was seen in 19%, greater than previously reported [1]. A higher proportion (35%) of patients discharged from the ICU had moderate-severe neurological disability; most subsequently died in hospital (62%). These figures may represent better ICU outcomes subsequent to adoption of OOHCA bundles but suggest further work is required in neuro-disabled survivors.

Authors’ Affiliations

(1)
Imperial College Healthcare NHS Trust

References

  1. Cobbe SM, et al.: BMJ. 1999, 312: 1633-1637.View ArticleGoogle Scholar
  2. Holzer M, et al.: N Engl J Med. 2002, 346: 549-556.View ArticleGoogle Scholar

Copyright

© Petrie et al.; licensee BioMed Central Ltd. 2013

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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