Long-term survival after successful inhospital cardiac arrest resuscitation.
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.
Bloom
Heather L
HL
Atlanta Veterans Affairs Medical Center, Decatur, GA 30033, USA. hbloom@emory.edu
Shukrullah
Irfan
I
Cuellar
Jose R
JR
Lloyd
Michael S
MS
Dudley
Samuel C
SC
Zafari
A Maziar
AM
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D003072:Cognition Disorders / Q000453:epidemiology; D015897:Comorbidity; D017147:Defibrillators, Implantable / Q000706:statistics & numerical data; D005845:Georgia / Q000453:epidemiology; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*; D016896:Treatment Outcome