Department of Clinical Science and Education, Center for Resuscitation Science, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, Solna, Sweden.
JAMA Netw Open. 2024 Oct 1;7(10):e2439196. doi: 10.1001/jamanetworkopen.2024.39196.
Brain injury is the leading cause of death following cardiac arrest and is associated with severe neurologic disabilities among survivors, with profound implications for patients and their families, as well as broader societal impacts. How these disabilities affect long-term survival is largely unknown.
To investigate whether complete neurologic recovery at hospital discharge after cardiac arrest is associated with better long-term survival compared with moderate or severe neurologic disabilities.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data from 4 mandatory national registers with structured and predefined data collection and nationwide coverage during a 10-year period in Sweden. Participants included adults who survived in-hospital cardiac arrest (IHCA) or out-of-hospital cardiac arrest (OHCA) beyond 30 days and who underwent predefined neurologic assessment conducted by health care professionals at hospital discharge using the Cerebral Performance Category (CPC) scale between January 2010 and December 2019. Patients were divided into 3 categories: complete recovery (CPC 1), moderate disabilities (CPC 2), and severe disabilities (CPC 3-4). Statistical analyses were performed in December 2023.
CPC score at hospital discharge.
The primary outcome was long-term survival among patients with CPC 1 compared with those with CPC 2 or CPC 3 or 4.
A total of 9390 cardiac arrest survivors (median [IQR] age, 69 .0 [58.0-77.0] years; 6544 [69.7%] male) were included. The distribution of functional neurologic outcomes at discharge was 7374 patients (78.5%) with CPC 1, 1358 patients (14.5%) with CPC 2, and 658 patients (7.0%) with CPC 3 or 4. Survival proportions at 5 years were 73.8% (95% CI, 72.5%-75.0%) for patients with CPC 1, compared with 64.7% (95% CI, 62.4%-67.0%) for patients with CPC 2 and 54.2% (95% CI, 50.6%-57.8%) for patients with CPC 3 or 4. Compared with patients with CPC 1, there was significantly higher hazard of death for patients with CPC 2 (adjusted hazard ratio [aHR], 1.57 [95% CI, 1.40-1.75]) or CPC 3 or 4 (aHR, 2.46 [95% CI, 2.13-2.85]). Similar associations were seen in the OHCA and IHCA groups.
In this cohort study of patients with cardiac arrest who survived beyond 30 days, complete neurologic recovery, defined as CPC 1 at discharge, was associated with better long-term survival compared with neurologic disabilities at the same time point.
脑损伤是心脏骤停后导致死亡的主要原因，幸存者中存在严重的神经功能障碍，这对患者及其家庭以及更广泛的社会都有深远的影响。这些残疾如何影响长期生存很大程度上是未知的。
研究与中度或重度神经功能障碍相比，心脏骤停后出院时完全神经恢复是否与更好的长期生存相关。
设计、设置和参与者：本队列研究使用了瑞典在 10 年期间来自 4 个强制性国家登记处的数据，这些登记处具有结构化和预定义的数据收集以及全国范围的覆盖。参与者包括在院内心脏骤停（IHCA）或院外心脏骤停（OHCA）后存活超过 30 天的成年人，并在出院时由医疗保健专业人员使用神经功能评估，使用大脑功能分类（CPC）量表进行预定义评估，时间为 2010 年 1 月至 2019 年 12 月。患者分为 3 类：完全恢复（CPC 1）、中度残疾（CPC 2）和重度残疾（CPC 3-4）。统计分析于 2023 年 12 月进行。
出院时的 CPC 评分。
主要结局是与 CPC 2 或 CPC 3 或 4 患者相比，CPC 1 患者的长期生存情况。
共纳入 9390 名心脏骤停幸存者（中位数[IQR]年龄，69.0[58.0-77.0]岁；6544 名[69.7%]男性）。出院时神经功能结局的分布为 7374 名患者（78.5%）为 CPC 1，1358 名患者（14.5%）为 CPC 2，658 名患者（7.0%）为 CPC 3 或 4。5 年生存率分别为 CPC 1 患者 73.8%（95%CI，72.5%-75.0%）、CPC 2 患者 64.7%（95%CI，62.4%-67.0%）和 CPC 3 或 4 患者 54.2%（95%CI，50.6%-57.8%）。与 CPC 1 患者相比，CPC 2（调整后的危险比[aHR]，1.57[95%CI，1.40-1.75]）或 CPC 3 或 4（aHR，2.46[95%CI，2.13-2.85]）患者的死亡风险明显更高。OHCA 和 IHCA 组也观察到类似的关联。
在这项对存活超过 30 天的心脏骤停患者的队列研究中，出院时定义为 CPC 1 的完全神经恢复与更好的长期生存相关，而与同一时间点的神经功能障碍相关。
