Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors

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Abstract

Objective:

To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest.

Design:

Observational, retrospective review of a prospectively collected cohort.

Setting:

Medical or surgical ICUs in a single tertiary care center.

Patients:

Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013.

Interventions:

None.

Measurements and Main Results:

Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3–4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1–15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2–13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03–0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06–0.9; p = 0.04).

Conclusions:

Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest.

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