Long-Term Outcomes of Out-of-Hospital Cardiac Arrest after Successful Early Defibrillation
T. Jared Bunch, M.D., Roger D. White, M.D., Bernard J. Gersh, M.B., Ch.B., Ryan A. Meverden, B.S., David O. Hodge, M.S., Karla V. Ballman, Ph.D., Stephen C. Hammill, M.D., Win-Kuang Shen, M.D., and Douglas L. Packer, M.D.
Background Mortality after out-of-hospital cardiac arrest fromventricular fibrillation is high. Programs focusing on earlydefibrillation have improved the rate of survival to hospitaldischarge. We conducted a population-based analysis of the long-termoutcome and quality of life of survivors.
Methods All patients who had an out-of-hospital cardiac arrestbetween November 1990 and January 2001 who received early defibrillationfor ventricular fibrillation in Olmsted County, Minnesota, wereincluded. The survival rate was compared with that of an age-,sex-, and disease-matched (2:1) control population of residentswho had not had an out-of-hospital cardiac arrest and with thatof age- and sex-matched controls from the general U.S. population.The quality of life was assessed with use of the Medical OutcomesStudy 36-item Short-Form General Health Survey (SF-36) and comparedwith U.S. population norms.
Results Of 200 patients who presented with an out-of-hospitalcardiac arrest with ventricular fibrillation, 145 (72 percent)survived to hospital admission (7 died in the emergency department)and 79 (40 percent) were neurologically intact (good overallcapability or moderate overall disability) at discharge. Themean (±SD) length of follow-up was 4.8±3.0 years.Nineteen patients died after discharge from the hospital. Theexpected five-year survival rate (79 percent) was identicalto that among age-, sex-, and disease-matched controls (P=0.68)but lower than that among the age- and sex-matched U.S. population(86 percent, P=0.02). Fifty patients completed SF-36 surveysat the end of follow-up, and the majority had a nearly normalquality of life, with the exception of reduced vitality.
Conclusions Long-term survival among patients who have undergonerapid defibrillation after out-of-hospital cardiac arrest issimilar to that among age-, sex-, and disease-matched patientswho did not have out-of-hospital cardiac arrest. The qualityof life among the majority of survivors is similar to that ofthe general population.
Source Information
From the Departments of Internal Medicine (T.J.B., R.D.W., B.J.G., S.C.H., W.-K.S., D.L.P.) and Anesthesiology (R.D.W.); the Division of Cardiovascular Diseases, Department of Internal Medicine (R.D.W., B.J.G., S.C.H., W.-K.S., D.L.P.); and the Division of Biostatistics, Department of Health Sciences Research (R.A.M., D.O.H., K.V.B.) — all at the Mayo Clinic, Rochester, Minn.
Address reprint requests to Dr. White at the Department of Anesthesiology and Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Mayo Foundation, 200 First St. SW, Rochester, MN 55905, or at white.roger{at}mayo.edu.
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