Moulaert Véronique R M, van Heugten Caroline M, Winkens Bjorn, Bakx Wilbert G M, de Krom Marc C F T M, Gorgels Ton P M, Wade Derick T, Verbunt Jeanine A
Adelante, Centre of Expertise in Rehabilitation and Audiology, Zandbergsweg 111, 6432 CC Hoensbroek, The Netherlands; CAPHRI School for Public Health and Primary Care, Department of Rehabilitation Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
School for Mental Health and Neuroscience, Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands.
Int J Cardiol. 2015 Aug 15;193:8-16. doi: 10.1016/j.ijcard.2015.04.229. Epub 2015 Apr 30.
Survivors of a cardiac arrest frequently have cognitive and emotional problems and their quality of life is at risk. We developed a brief nursing intervention to detect cognitive and emotional problems, provide information and support, promote self-management, and refer them to specialised care if necessary. This study examined its effectiveness.
Multicentre randomised controlled trial with measurements at two weeks, three months and twelve months after cardiac arrest. 185 adult cardiac arrest survivors and 155 caregivers participated. Primary outcome measures were societal participation and quality of life of the survivors at one year. Secondary outcomes were the patient's cognitive functioning, emotional state, extended daily activities and return to work, and the caregiver's well-being. Data were analysed using 'intention to treat' linear mixed model analyses.
After one year, patients in the intervention group had a significantly better quality of life on SF-36 domains Role Emotional (estimated mean differences (EMD)=16.38, p=0.006), Mental Health (EMD=6.87, p=0.003) and General Health (EMD=8.07, p=0.010), but there was no significant difference with regard to societal participation. On the secondary outcome measures, survivors scored significantly better on overall emotional state (HADS total, EMD=-3.25, p=0.002) and anxiety (HADS anxiety, EMD=-1.79, p=0.001) at one year. Furthermore, at three months more people were back at work (50% versus 21%, p=0.006). No significant differences were found for caregiver outcomes.
The outcomes of cardiac arrest survivors can be improved by an intervention focused on detecting and managing the cognitive and emotional consequences of a cardiac arrest.
Current controlled trials, ISRCTN74835019.
心脏骤停幸存者常常存在认知和情感问题，其生活质量面临风险。我们开展了一项简短的护理干预措施，以检测认知和情感问题、提供信息与支持、促进自我管理，并在必要时将他们转介至专科护理。本研究对其有效性进行了检验。
多中心随机对照试验，在心脏骤停后两周、三个月和十二个月进行测量。185名成年心脏骤停幸存者和155名护理人员参与其中。主要结局指标为幸存者一年后的社会参与度和生活质量。次要结局包括患者的认知功能、情绪状态、扩展的日常活动和重返工作情况，以及护理人员的幸福感。数据采用“意向性分析”线性混合模型分析。
一年后，干预组患者在SF-36量表的角色情感（估计平均差异（EMD）=16.38，p=0.006）、心理健康（EMD=6.87，p=0.003）和总体健康（EMD=8.07，p=0.010）领域的生活质量显著更好，但在社会参与方面没有显著差异。在次要结局指标方面，幸存者在一年时的总体情绪状态（医院焦虑抑郁量表总分，EMD=-3.25，p=0.002）和焦虑（医院焦虑抑郁量表焦虑分量表，EMD=-1.79，p=0.001）得分显著更好。此外，在三个月时，更多人重返工作岗位（分别为50%和21%，p=0.006）。在护理人员结局方面未发现显著差异。
针对检测和管理心脏骤停的认知和情感后果的干预措施可改善心脏骤停幸存者的结局。
国际标准随机对照试验编号，ISRCTN74835019 。
