Life after death: posttraumatic stress disorder in survivors of cardiac arrest--prevalence, associated factors, and the influence of sedation and analgesia.
OBJECTIVE
Cardiac arrest is possibly one of the most traumatizing conditions for patients, but to date, its influence on psychic morbidity remains unknown. Posttraumatic stress disorder is a unique symptom configuration after an extreme event consisting of intrusion re-experiencing, avoidance and numbness, and hyperarousal symptoms. We studied a) the prevalence of posttraumatic stress disorder (PTSD) in long term survivors of cardiac arrest; b) the role of specific stress factors related to cardiac arrest for the development of PTSD; and c) the influence of sedation and analgesia during or after cardiac arrest on the occurrence of PTSD.


METHODS
Prospective, cohort study.


METHODS
University teaching hospital.


METHODS
Analysis was performed in cardiac arrest survivors who were discharged with favorable neurologic outcome during an 8-yr period (1991-1999).


METHODS
All patients received the Davidson Trauma Score for the assessment of PTSD and a modified German version of the EuroQol questionnaire for assessment of quality of life. Cardiac arrest circumstances and administration of sedation and analgesia were assessed.


RESULTS
Of 1,630 initially resuscitated patients, 270 patients were discharged with good neurologic outcome. A total of 226 patients were contacted, and 143 patients (63% of all eligible patients) completed the study. Mean time from cardiac arrest to follow up was 45 months (range, 24-66). Thirty-nine patients (27%; 95% confidence interval, 21% to 35%) had a Davidson Trauma Score >40 and fulfilled criteria for PTSD. Patients with PTSD had a significantly lower quality of life. The only independent risk factor for the development of PTSD was younger age. There was no difference between patients with or without PTSD regarding the use of sedation and analgesia during or after cardiac arrest.


CONCLUSIONS
The prevalence of PTSD in cardiac arrest survivors is high. Besides younger age, neither clinical factors nor the use of sedation and analgesia were associated with development of PTSD.
Gamper
Gunnar
G
University Clinic of Emergency Medicine, University of Vienna, Austria.
Willeit
Matthaeus
M
Sterz
Fritz
F
Herkner
Harald
H
Zoufaly
Alexander
A
Hornik
Kurt
K
Havel
Christof
C
Laggner
A N
AN
D000328:Adult; D000368:Aged; D000698:Analgesia; D016292:Procedural Sedation; D005260:Female; D006323:Heart Arrest / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000209:etiology; D017741:Survivors; D013997:Time Factors