title: Predictors of long-term survival after out-of-hospital cardiac arrest: the impact of Activities of Daily Living and Cerebral Performance Category scores.
abstract: BACKGROUND
  Current focus on immediate survival from out-of-hospital cardiac arrest (OHCA) has diverted attention away from the variables potentially affecting long-term survival.
  
  
  OBJECTIVE
  To determine the relationship between neurological and functional status at hospital discharge and long-term survival after OHCA.
  
  
  METHODS
  Prospective data collection for all OHCA patients aged >18 years in the Jerusalem district (n=1043, 2008-2009).
  
  
  METHODS
  Length of survival after OHCA. Potential predictors: Activities of Daily Living (ADL) and Cerebral Performance Category (CPC) scores at hospital discharge, age and sex.
  
  
  RESULTS
  There were 52/279 (18.6%) survivors to hospital discharge. Fourteen were discharged on mechanical ventilation (27%). Interviews with survivors and/or their legal guardians were sought 2.8±0.6 years post-arrest. Eighteen died before long-term follow-up (median survival 126 days, IQR 94-740). Six improved their ADL and CPC scores between discharge and follow-up. Long-term survival was positively related with lower CPC scores (p=0.002) and less deterioration in ADL from before the arrest to hospital discharge (p=0.001). For each point increment in ADL at hospital discharge, the hazard ratio of death was 1.31 (95%CI 1.12, 1.53, p=0.001); this remained unchanged after adjustment for age and sex (HR 1.26, 95%CI 0.07, 1.48, p=0.005).
  
  
  CONCLUSIONS
  One-third of the patients discharged from hospital after OHCA died within 30 months of the event. Long-term survival was associated both with better neurological and functional level at hospital discharge and a smaller decrease in functional limitation from before to after the arrest, yet some patients with a poor neurological outcome survived prolonged periods after hospital discharge.
authors.affiliation: Hebrew University-Hadassah Faculty of Medicine, Ein Kerem, Jerusalem, Israel; Paramedic, Magen David Adom, Jerusalem, Israel.
authors.forename: Gal
authors.initials: G
authors.lastname: Pachys
authors.affiliation: Intensive Care Unit, Department of Emergency Medicine, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: Nechama
authors.initials: N
authors.lastname: Kaufman
authors.affiliation: Hebrew University-Hadassah Faculty of Medicine, Ein Kerem, Jerusalem, Israel.
authors.forename: Tali
authors.initials: T
authors.lastname: Bdolah-Abram
authors.affiliation: Epidemiology Unit, Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Ein Kerem, Jerusalem, Israel.
authors.forename: Jeremy D
authors.initials: JD
authors.lastname: Kark
authors.affiliation: Hebrew University-Hadassah Faculty of Medicine, Ein Kerem, Jerusalem, Israel; Surgical Intensive Care, Shaare Zedek Medical Center, Israel. Electronic address: einav_s@szmc.org.il.
authors.forename: Sharon
authors.initials: S
authors.lastname: Einav
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003071:Cognition / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D010351:Patient Discharge / Q000639:trends; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Activities of Daily Living; Brain damage; Cardiopulmonary resuscitation; Life expectancy; Prognosis; Survival