Long term clinical outcomes in survivors after out-of-hospital cardiac arrest

Published:December 19, 2019DOI:


      • Data regarding clinical long-term outcomes after OHCA are scarce.
      • OHCA survivors face significant morbidity and mortality after the index event.
      • Neurological outcome, time from CA to CPR, age and LVEF were predictors of worse f/u.
      • Clinically relevant events during f/u were not always directly related with the CA.
      • Survivors may benefit from multidisciplinary teams providing integral management.


      Introduction and objectives

      Information regarding long-term outcomes in patients surviving out-of-hospital cardiac arrest (OHCA) is scarce. Our aim was to study the long-term clinical outcomes of a large cohort of OHCA patients surviving until hospital discharge and to identify predictors of mortality and cardiovascular events.


      Consecutive OHCA patients admitted in the Acute Cardiac Care Unit who survived at least until hospital discharge between 2007 and 2019 were included. All received therapeutic hypothermia according to the local protocol. Pre- and intra-hospital clinical and analytical variables were analyzed, as well as the clinically relevant events during follow-up.


      A total of 201 patients were included, with a mean age of 57.6 ± 14.2 years, 168 (83.6%) were male. Thirty-six (17.9%) died during a median follow-up of 40.3 months (18.9–69.1), the most frequent causes of death being cardiovascular and neurological, followed by cancer. We calculated a predictive model for mortality during follow-up using Cox regression that included the following variables: poor neurological outcome [HR 3.503 (1.578–7.777)], non-shockable rhythm [HR 2.926 (1.390–6.163)], time to onset of CPR [HR 1.063 (0.997–1.134)], older age [1.036 (1.008–1.064)) and worse ejection fraction at discharge [1.033 (1.009–1.058)].


      Even though few patients experience recurrent cardiac arrest events, survivors after OHCA face high morbidity and mortality during long-term follow-up. Therefore, they may benefit from multidisciplinary teams providing an integral management and ensuring continuity of care.


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        • Rees N.
        • Finn J.
        • Stallard N.
        • et al.
        A randomized trial of epinephrine in out-of-hospital cardiac arrest.
        N Engl J Med. 2018; 379: 711-721
        • Laver S.
        • Farrow C.
        • Turner D.
        • Nolan J
        Mode of death after admission to an intensive care unit following cardiac arrest.
        Intensive Care Med. 2004; 30: 2126-2128
        • Dragancea I.
        • Rundgren M.
        • Englund E.
        • Friberg H.
        • Cronberg T
        The influence of induced hypothermia and delayed prognostication on the mode of death after cardiac arrest.
        Resuscitation. 2013; 84: 337-342
        • Rosell F.
        • Mellado F.
        • Lo J.B.
        • et al.
        Supervivencia y estado neurológico tras muerte súbita cardiaca extrahospitalaria. resultados del registro andaluz de parada cardiorrespiratoria extrahospitalaria.
        Rev Española Cardiol. 2016; 69: 494-500
        • Callaway C.W.
        • Donnino M.W.
        • Fink E.L.
        • et al.
        Part 8: post-cardiac arrest care: 2015 American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2015; 132: S465-S482
        • Nielsen N.
        • Wetterslev J.
        • Cronberg T.
        • et al.
        Targeted temperature management at 33. versus 36. after cardiac arrest.
        N Engl J Med. 2013; 369: 2197-2206
        • Cronberg T.
        • Lilja G.
        • Horn J.
        • et al.
        Neurologic function and health-related quality of life in patients following targeted temperature management at 33° vs 36° after out-of-hospital cardiac arrest.
        JAMA Neurol. 2015; 72: 634
        • Lopez-de-Sa E.
        • Juarez M.
        • Armada E.
        • et al.
        A multicentre randomized pilot trial on the effectiveness of different levels of cooling in comatose survivors of out-of-hospital cardiac arrest: the frost-I trial.
        Intensive Care Med. 2018; 1;44: 1807-1815
        • Pérez-Castellanos A.
        • Martínez-Sellés M.
        • Uribarri A.
        • Devesa-Cordero C.
        • Sánchez-Salado J.C.
        • Ariza-Solé A.
        • et al.
        Development and External Validation of an Early Prognostic Model for Survivors of Out-of-hospital Cardiac Arrest.
        Rev Esp Cardiol (Engl Ed). 2019; 72: 535-542
        • Redpath C.
        • Sambell C.
        • Stiell I.
        • et al.
        In-hospital mortality in 13,263 survivors of out-of-hospital cardiac arrest in Canada.
        Am Heart J. 2010; 159: 577-583
        • Kirkegaard H.
        • Sreide E.
        • De Haas I.
        • et al.
        Targeted temperature management for 48 vs 24 h and neurologic outcome after out-of-hospital cardiac arrest: a randomized clinical trial.
        JAMA. 2017; 318: 341-350
        • Hayashi M.
        • Shimizu W.
        • Albert C.M
        The spectrum of epidemiology underlying sudden cardiac death.
        Circ Res. 2015 Jun 5; 116: 1887-1906
        • Rivero F.
        • Bastante T.
        • Cuesta J.
        • et al.
        Factores asociados al retraso en la demanda de atención médica en pacientes con síndrome coronario agudo con elevación del segmento St.
        Rev Esp Cardiol. 2016 Mar 1; 69: 279-285
        • King K.B.
        • McGuire M.A.
        Symptom presentation and time to seek care in women and men with acute myocardial infarction.
        Heart Lung. 2007; 36: 235-243
        • Lovlien M.
        • Schei B.
        • Hole T
        Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction.
        Eur J Cardiovasc Nurs. 2007; 6: 308-313
        • Wissenberg M.
        • Hansen C.M.
        • Folke F.
        • et al.
        Survival after out-of-hospital cardiac arrest in relation to sex: a nationwide registry-based study.
        Resuscitation. 2014; 85: 1212-1218
        • Akahane M.
        • Ogawa T.
        • Koike S.
        • et al.
        The effects of sex on out-of-hospital cardiac arrest outcomes.
        Am J Med. 2011; 124: 325-333
      1. Dumas F, White L, Stubbs BA, Cariou A, Rea TD. Long-Term Prognosis Following Resuscitation From Out of Hospital Cardiac Arrest Role of Percutaneous Coronary Intervention and Therapeutic Hypothermia. J Am Coll Cardiol. 2012 Jul 3;60(1):21-7.

        • Smith K.
        • Epi G.D.
        • Cert G.
        • et al.
        Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest.
        Circulation. 2014; : 174-181
        • Shuvy M.
        • Morrison L.J.
        • Koh M.
        • et al.
        Long-term clinical outcomes and predictors for survivors of out-of-hospital cardiac arrest.
        Resuscitation. 2017; 112: 59-64
        • Chan P.S.
        • McNally B.
        • Nallamothu B.K.
        • et al.
        Long-term outcomes among elderly survivors of out-of-hospital cardiac arrest.
        J Am Heart Assoc. 2015; 5: 1-9
      2. Instituto Nacional de Estadística (INE). Estadística de defunciones según la causa de muerte2017.

        • Caro-Codón J.
        • Rey J.R.
        • Lopez de Sá E.
        • et al.
        Long-term neurological outcomes in out-of-hospital cardiac arrest patients treated with targeted-temperature management.
        Resuscitation. 2018; 133: 33-39
        • Caro-Codón J.
        • Rey J.R.
        • Lopez de Sá E.
        • et al.
        Dataset regarding baseline and follow-up characteristics of out-of-hospital cardiac arrest patients focused on neurological outcomes.
        Data Brief. 2018 27; 21: 1140-1144
        • World Health Organization
        Depression and other common mental disorders: global health estimates.
        World Health Organization, 2017: 1-24
        • González-Salvado V.
        • Rodríguez-Núñez A.
        • González-Juanatey J.R
        De la prevención a la rehabilitación: hacia un manejo integral de la parada cardiaca.
        Rev Esp Cardiol. 2019; 1;72: 3-6
        • Moulaert V.R.M.
        • Van Heugten C.M.
        • Winkens B.
        • et al.
        Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial.
        Int J Cardiol. 2015; 193: 8-16

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