Abstracts
Health related quality of life after refractory cardiac arrest treated with conventional or extracorporeal CPR
Inhoud:

    Auteur(s):

    Anina van de Koolwijk1, Thijs Delnoij2,  Martje Suverein1, Brigitte Essers3, Iwan van der Horst1, Bjorn Winkens4, Jos Maessen5, Roberto Lorusso5, Marcel van de Poll on behalf of the INCEPTION1 investigators1

     

    1Departement of Intensive Care Medicine, Maastricht University Medial Centre+, Maastricht University, Maastricht, the Netherlands

    2Departement of Intensive Care Medicine and Departement of Cardiologie, Maastricht University Medial Centre+, Maastricht University, Maastricht, the Netherlands

    3Departement of Clinical Epidemiology and Medical Technical Assessment, Maastricht University Medial Centre+, Maastricht University, Maastricht, the Netherlands

    4Departement of Methodology & Statistics and Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands

    5Departement of Cardiothoracic Surgery, Maastricht University Medial Centre+, Maastricht University, Maastricht, the Netherlands
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    Abstracts

    Health related quality of life after refractory cardiac arrest treated with conventional or extracorporeal CPR

    Teaser: Er is weinig bekend over de levenskwaliteit na een refractaire hartstilstand en over de invloed van extracorporele reanimatie (ECPR) hierop. Bij 25 overlevers van refractaire hartstilstand, waarvan 5 behandeld werden met ECPR, werd gedurende een jaar de levenskwaliteit gemeten. Van hen had 68% een goede functionele uitkomst. Er was geen verschil tussen ECPR en conventionele reanimatie.

    Background: Out-of-hospital cardiac arrest (OHCA) is an adverse event with high mortality. Extracorporeal cardiopulmonary resuscitation (ECPR) is emerging as a promising intervention to improve outcome. While survival is important, there is increasing attention for neurological outcome, assessed by e.g. the Cerebral Performance Category (CPC) score. However, such scores do not necessarily correlate with functional outcome and health related quality of life (HRQoL). The aims of this study were to determine HRQoL and functional outcome during 1-year in survivors of refractory OHCA, treated with ECPR or conventional CPR (CCPR) and to assess factors associated with functional outcome in these patients.

    Methods: This is a post-hoc analysis of a multicenter randomized clinical trial, that studied the effectiveness of ECPR in patients with refractory OHCA (no return of spontaneous circulation after >15 minutes advanced life support). We prospectively assessed HRQoL using the EQ-5D-5L questionnaire at 1, 3, 6 and 12 months after OHCA. Based on the EQ-5D-5L health utility index at the last follow-up, we categorized functional outcome as good or poor. Poor functional outcome was defined as an EQ-5D-5L health utility index >1 standard deviation below the age adjusted norm. Data on HRQoL during follow-up were analyzed using mixed linear models. Univariable analyses were performed to assess factors potentially associated with functional outcome.

    Results: We enrolled 134 patients, 55 received ECPR and 79 CCPR. Overall hospital survival was 20% (27 patients), 5 (9%) patients survived after ECPR and 22 (28%) after CCPR. EQ-5D-5L data were available for 25 patients (5 ECPR (100%), 20 CCPR (91%)). One year after OHCA, estimated mean health utility index was 0.84±0.12 versus 0.71±0.05 in ECPR versus CCPR survivors respectively (p-value 0.31) (Figure 1). Overall estimated mean health utility index was 0.73±0.05. Eight of 25 (32%) survivors had a poor functional outcome. All ECPR survivors versus 60% of the CCPR survivors had a good functional outcome (p-value 0.14). We identified no specific factors that were associated with functional outcome (Table 1). CPC scores were distributed similarly between patients with good and poor functional outcome (p=0.62).

    Conclusions: In conclusion, one year after refractory OHCA, 68% of the survivors have a good functional outcome. We found no statistically significant difference in health-related quality of life and functional outcome in survivors of refractory OHCA treated with ECPR or CCPR and no factors that were associated with functional outcome.

    Figure 1: Estimated mean health utility index over time in survivors of refractory OHCA surviving through extracorporeal CPR (n=5) versus conventional CPR (n=20)

    Table 1: Factors associated with functional outcome in refractory out of hospital cardiac arrest