Neurological rehabilitation of severely disabled cardiac arrest survivors. Part I. Course of post-acute inpatient treatment.
BACKGROUND
Some survivors of out-of-hospital cardiac arrest (CA) sustain anoxic brain injury. The aim of this study was to offer these patients a new treatment approach, to describe the course and outcome of rehabilitation, and to judge whether rehabilitation provided benefit.


METHODS
Twenty severely disabled patients (mean age 47.6 years, 17 M:3 F) were admitted for inpatient rehabilitation after sustaining anoxic brain damage secondary to CA. The multidisciplinary treatment approach aimed at orientation, communication, mobility, and self care. Function was assessed using Barthel index (BI) score. On discharge, placement and global outcome was noted. Medical charts of consecutive patients were reviewed retrospectively.


RESULTS
Inpatient rehabilitation lasted on for average 12 weeks. Improvement in function was slow with a median increase of 1.88 BI score per week. Patients achieved clinically significant functional improvement as measured by pre-post comparison of BI (P<0.001). On discharge, overall disability was mild in 2 (10%), moderate in 7 (35%), and severe in 11 (55%) patients.


CONCLUSIONS
Rehabilitation of selected CA survivors is appropriate, reducing the subsequent burden of care. Although in 55%, only minor dependence on care persisted, on a group level, the potential for rehabilitation was modest, and recovery curve was flat. Before admission, families should be given realistic information about the possible outcome, because independence was rarely achieved.
Fertl
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E
Department of Neurological Rehabilitation, University of Vienna Medical School, Währinger Gürtel 18-20, A-1097 Vienna, Austria. elisabeth.fertl@univie.ac.at
Vass
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Sterz
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Gabriel
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H
Auff
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D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000534:rehabilitation; D006233:Persons with Disabilities / Q000534:rehabilitation* / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000534:rehabilitation*; D006801:Humans; D002534:Hypoxia, Brain / Q000209:etiology / Q000534:rehabilitation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017741:Survivors / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000534:rehabilitation