Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest

T Spangenberg; J Schewel; A Dreher; F Meincke; E Bahlmann; H van der Schalk; F Kreidel; C Frerker; M Stoeck; B Bein; K-H Kuck; A Ghanem

doi:10.1016/j.resuscitation.2018.03.036

Health related quality of life after extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest

Resuscitation. 2018 Jun:127:73-78. doi: 10.1016/j.resuscitation.2018.03.036. Epub 2018 Apr 4.

Authors

T Spangenberg¹, J Schewel², A Dreher², F Meincke², E Bahlmann², H van der Schalk², F Kreidel², C Frerker², M Stoeck³, B Bein³, K-H Kuck², A Ghanem⁴

Affiliations

¹ Asklepios Klinik St Georg, Dept. of Cardiology, Hamburg, Germany. Electronic address: t.spangenberg@asklepios.com.
² Asklepios Klinik St Georg, Dept. of Cardiology, Hamburg, Germany.
³ Asklepios Klinik St Georg, Dept. of Anesthesiology, Hamburg, Germany.
⁴ Asklepios Klinik St Georg, Dept. of Cardiology, Hamburg, Germany; University Heart Center Bonn, Dept. of Cardiology, Bonn, Germany.

PMID: 29626610
DOI: 10.1016/j.resuscitation.2018.03.036

Abstract

Background: Recent data identifies extracorporeal cardio-pulmonary resuscitation (eCPR) as a potential addendum of conventional cardiopulmonary-resuscitation (cCPR) in highly specified circumstances and selected patients. However, consented criteria indicating eCPR are lacking. Therefore we provide first insights into the health-related quality of life (HRQoL) outcomes of patients treated with eCPR in a real world setting.

Methods: Retrospective single-center experience of 60 consecutive patients treated with eCPR between 01/2014 and 06/2016 providing 1-year survival- and HRQoL data obtained through the Short-Form 36 Survey (SF-36) after refractory out-of-hospital- (OHCA) and in-hospital cardiac arrest (IHCA) of presumed cardiac etiology.

Results: Resuscitation efforts until initiation of eCPR averaged 66 ± 35 min and 63.3% of the patients suffered from OHCA. Fifty-five (91.7%) of the overall events were witnessed and bystander-CPR was performed in 73.3% (n = 44) of cases. Cause of arrest was dominated by acute myocardial infarction (AMI, 66.7%) and initial rhythm slightly outbalanced by ventricular fibrillation/tachycardia (VF/VT 53.3%). 12-month survival was 31%. Survivors experienced more often bystander-CPR (p = .001) and a shorter duration of cCPR (p = .002). While mid-term survivors' perceived HRQoL was compromised compared to controls (p ≦ .0001 for PF, RP, RE and BP; p = .007 for GH; p = .016 for SF; p = .030 for MH; p = .108 for VT), scores however resembled HRQoL of subjects on hemodialysis, following cardiogenic shock or pulmonary failure treated with extracorporeal membrane oxygenation (ECMO).

Conclusions: While HRQoL scores of our survivors ranged markedly below controls, compared to patients on chronic hemodialysis, following ECMO for cardiogenic shock or pulmonary failure most of the discrepancies ameliorated. Thus, successfull eCPR in properly selected patients does translate into an encouraging HRQoL approximating chronic renal failure.

Keywords: Cardiac arrest; ECLS; ECMO; ECPR; Extracorporeal resuscitation; Refractory arrest; Resuscitation.

MeSH terms

Aged
Cardiopulmonary Resuscitation / methods*
Cardiopulmonary Resuscitation / mortality
Extracorporeal Membrane Oxygenation / methods*
Extracorporeal Membrane Oxygenation / mortality
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Quality of Life*
Recovery of Function
Retrospective Studies
Statistics, Nonparametric
Surveys and Questionnaires
Time Factors