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. 2007 May;153(5):831-6.
doi: 10.1016/j.ahj.2007.02.011.

Long-term survival after successful inhospital cardiac arrest resuscitation

Heather L Bloom  1 , Irfan Shukrullah, Jose R Cuellar, Michael S Lloyd, Samuel C Dudley Jr, A Maziar Zafari
Affiliations

Long-term survival after successful inhospital cardiac arrest resuscitation

Heather L Bloom et al. Am Heart J. 2007 May.

Abstract

Background: Little is known about long-term outcomes of patients who survive inhospital cardiac arrest.

Methods: We examined long-term survival after inhospital cardiac arrest and whether procedural changes that improved survival to discharge impacted long-term survival. Consecutive inhospital arrests in the Atlanta Veterans Affairs Medical Center (Atlanta, GA) from 1995 to 2004 (n = 732) were retrospectively analyzed. Data regarding the arrest was obtained, including age, left ventricular ejection fraction, medications, and comorbidities, presenting rhythm, location of arrest, code duration, and outcomes. Long-term mortality data was obtained based on chart and Social Security Death Index reviews. Further data was gathered on internal cardioverter-defibrillator presence and use in survivors.

Results: Overall, 49 subjects (6.6%) survived to discharge. Univariate analysis found that ventricular tachycardia/ventricular fibrillation and the use of beta-blockers, angiotensin-converting enzyme inhibitors, and antiarrhythmics at the time of arrest were associated with increased survival, whereas advancing age and comorbidities were associated with a higher risk of mortality. Multivariate analysis determined that age, rhythm, and comorbidities independently affected survival. Implementation of a resuscitation program previously documented to improve survival to discharge did not translate to durable long-term survival. Three-year survival rate after discharge was only 41%. Alternatively, subjects with internal cardioverter-defibrillator showed a 36% improvement in 3-year survival rate to 77% (P = .001).

Conclusions: Subjects with inhospital cardiac arrest have poor long-term prognoses. A strategy that improved inhospital survival did not alter long-term mortality rate. Thus, survival to discharge may not be a sufficient end point for future resuscitation trials.

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Figures

Figure 1
Figure 1
Odds ratios for survival by significant clinical characteristics between survivors to discharge and nonsurvivors of inhospital cardiac arrest. Error bars represent 95% CIs.
Figure 2
Figure 2
Kaplan-Meier survival curves comparing survival of subjects before (solid line) and after (dashed line) the implementation of a program designed to improve survival to discharge. Despite improvement in absolute survival rates after program implementation, survival trends are identical.
Figure 3
Figure 3
Kaplan-Meier survival curves comparing long-term survival of inhospital cardiac arrest survivors with (solid line) and without (dashed line) ICDs. Recipients of ICD have significantly improved survival rates.
See this image and copyright information in PMC

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