Survival of 1476 patients initially resuscitated from out of hospital cardiac arrest

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Abstract
Objectives: To determine the short and long term outcome of patients admitted to hospital after initially successful resuscitation from cardiac arrest out of hospital. Design: Review of ambulance and hospital records. Follow up of mortality by “flagging” with the registrar general. Cox proportional hazards analysis of predictors of mortality in patients discharged alive from hospital. Setting: Scottish Ambulance Service and acute hospitals throughout Scotland. Subjects: 1476 patients admitted to a hospital ward, of whom 680 (46%) were discharged alive. Main outcome measures: Survival to hospital discharge, neurological status at discharge, time to death, and cause of death after discharge. Results: The median duration of hospital stay was 10 days (interquartile range 8-15) in patients discharged alive and 1 (1-4) day in those dying in hospital. Neurological status at discharge in survivors was normal or mildly impaired in 605 (89%), moderately impaired in 58 (8.5%), and severely impaired in 13 (2%); one patient was comatose. Direct discharge to home occurred in 622 (91%) cases. The 680 discharged survivors were followed up for a median of 25 (range 0-68) months. There were 176 deaths, of which 81 were sudden cardiac deaths, 55 were non-sudden cardiac deaths, and 40 were due to other causes. The product limit estimate of 4 year survival after discharge was 68%. The independent predictors of mortality on follow up were increased age, treatment for heart failure, and cardiac arrest not due to definite myocardial infarction. Conclusion: About 40% of initial survivors of resuscitation out of hospital are discharged home without major neurological disability. Patients at high risk of subsequent cardiac death can be identified and may benefit from further cardiological evaluation. Nearly 70% of patients discharged after cardiac arrest are alive four years after the event Patients whose cardiac arrest is not due to definite myocardial infarction require further cardiological assessment