Quality-of-Life and Formal Functional Testing of Survivors of Out-of-Hospital Cardiac Arrest Correlates Poorly With Traditional Neurologic Outcome Scales☆,☆☆,★
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INTRODUCTION
The neurologic function and quality of life of long-term survivors of cardiac arrest are obviously of great importance, certainly as important as survival alone. Despite this importance, previous studies of neurologic function in long-term survivors of cardiac arrest have been few, and none has assessed subjective quality of life. By far the most common neurologic scoring method for cardiac arrest survivors is the simple five-point CPC (Cerebral Performance Category) score. This scale is poorly
MATERIALS AND METHODS
Our study population comprised all patients in San Francisco who sustained out-of-hospital cardiac arrest between February 1989 and June 1993 and were discharged alive from the hospital. During this period, the San Francisco emergency medical services system had first responders with defibrillators on fire trucks, with an average response interval of approximately 4 minutes; and advanced life support (ALS) ambulances with two paramedics, with an average response interval of approximately 10
RESULTS
Between February 1989 and June 1993, 3,130 out-of-hospital cardiac arrests occurred in San Francisco. Paramedics refrained from instituting ALS measures, as indicated by local EMS protocols, in 626 (20%). We identified 126 patients in the various databases as having survived to hospital discharge, but careful review of records revealed that only 93 (74%) had sustained true arrests and survived to hospital discharge. Eight patients had actually died in the hospital, despite initial reports to
DISCUSSION
Quality of life and neurologic function are key outcomes in the successful resuscitation of a cardiac arrest victim, but they have been studied little. The authors of most existing studies have focused on short-term recovery, such as the prediction of awakening or discharge from hospital based on findings in the first few days after arrest.19, 20, 21, 22 The GCS, a validated instrument, is commonly used in these studies to assess short-term recovery, but never beyond a week or two of
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Cited by (0)
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From the School of Medicine, University of California at Los Angeles*, the Division of Emergency Medicine, University of California, San Francisco‡ and the San Francisco Department of Public Health§, San Francisco, California.
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Reprints not available from the authors.
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Reprint no. 47/1/77996