Sudden Cardiac Arrest Survivorship: A Scientific Statement From the American Heart Association

Mean arterial pressure is associated with the neurological function in patients who survived after cardiopulmonary resuscitation: A retrospective cohort study

Background

About 18% to 40% of the survivors have moderate to severe neurological dysfunction. At present, studies on mean arterial pressure (MAP) and neurological function of patients survived after cardiopulmonary resuscitation (CPR) are limited and conflicted.

Hypothesis

The higher the MAP of the patient who survived after CPR, the better the neurological function.

Method

A retrospective cohort study was conducted to detect the relationship between MAP and the neurological function of patients who survived after CPR by univariate analysis, multivariate regression analysis, and subgroup analysis.

Results

From January 2007 to December 2015, a total of 290 cases met the inclusion criteria and were enrolled in this study. The univariate analysis showed that MAP was associated with the neurological function of patients who survived after CPR; its OR value was 1.03 (1.01, 1.04). The multi‐factor regression analysis also showed that MAP was associated with the neurological function of patients survived after CPR in the four models, the adjusted OR value of the four models were 1.021 (1.008, 1.035); 1.028 (1.013, 1.043); 1.027 (1.012, 1.043); and 1.029 (1.014, 1.044), respectively. The subgroups analyses showed that when 65 mm Hg ≤ MAP<100 mm Hg and when patients with targeted temperature management or without extracorporeal membrane oxygenation, with the increase of MAP, the better neurological function of patients survived after CPR.

Conclusion

This study found that the higher MAP, the better the neurological function of patients who survived after CPR. At the same time, the maintenance of MAP at 65 to 100 mm Hg would improve the neurological function of patients who survived after CPR.

Modifiable provider-patient relationship factors and illness perceptions are associated with quality of life in survivors of cardiac arrest with good neurologic recovery

Aim

To evaluate associations between provider-patient communication, readiness for discharge, and patients' illness perceptions with post-arrest quality of life (QoL).

Methods

We distributed an online survey to survivors of cardiac arrest who were members of the Sudden Cardiac Arrest Foundation. Survivors completed the Questionnaire for the Quality of Provider-Patient Interactions (QQPPI), Readiness for Hospital Discharge Scale (RHDS), and the Brief Illness Perception Questionnaire (B-IPQ). When completing the QQPPI and RHDS, survivors were asked to think back to their hospitalization and discharge. QoL domains (physical, psychological, social) were measured via the WHO-QOL BREF. Three multiple regression models examined associations between QQPPI, RHDS, and B-IPQ scores with QoL domains, adjusted for age, sex, months since arrest, self-reported understanding of cardiac arrest and potential post-arrest symptoms at discharge, self-reported memory at discharge, and functional status as defined by the Lawton Instrumental Activities of Daily Living scale.

Results

A total of 163 survivors (mean age: 50.1 years, 50.3% women, 95.5% white, mean time since arrest: 63.9 months) provided complete survey data. More threatening illness perceptions (β: -0.45, p ​< ​0.001) and lower readiness for discharge (β: 0.21, p ​= ​0.01) were associated with worse physical QoL. More threatening illness perceptions (β: -0.47, p ​< ​0.001) was associated with worse psychological QoL. More threatening illness perceptions (β: -0.28, p ​= ​0.001) and poor provider-patient communication (β: 0.35, p ​< ​0.001) were associated with worse social QoL.

Conclusions

Modifiable provider-patient relationship factors and illness perceptions were associated with quality of life in survivors of cardiac arrest with good neurologic recovery.