Determinants of Long-Term Neurological Recovery Patterns Relative to Hospital Discharge Among Cardiac Arrest Survivors

Objective: To explore factors associated with neurological recovery at 1 year relative to hospital discharge after cardiac arrest. Design: Observational, retrospective review of a prospectively collected cohort. Setting: Medical or surgical ICUs in a single tertiary care center. Patients: Older than 18 years, resuscitated following either in-hospital or out-of-hospital cardiac arrest and considered for targeted temperature management between 2007 and 2013. Interventions: None. Measurements and Main Results: Logistic regressions to determine factors associated with a poor recovery pattern after 1 year, defined as persistent Cerebral Performance Category Score 3–4 or any worsening of Cerebral Performance Category Score relative to discharge status. In total, 30% (117/385) of patients survived to hospital discharge; among those discharged with Cerebral Performance Category Score 1, 2, 3, and 4, good recovery pattern was seen in 54.5%, 48.4%, 39.5%, and 0%, respectively. Significant variables showing trends in associations with a poor recovery pattern (62.5%) in a multivariate model were age more than 70 years (odds ratio, 4; 95% CIs, 1.1–15; p = 0.04), Hispanic ethnicity (odds ratio, 4; CI, 1.2–13; p = 0.02), and discharge disposition (home needing out-patient services (odds ratio, 1), home requiring no additional services (odds ratio, 0.15; CI, 0.03–0.8; p = 0.02), acute rehabilitation (odds ratio, 0.23; CI, 0.06–0.9; p = 0.04). Conclusions: Patients discharged with mild or moderate cerebral dysfunction sustained their risk of neurological worsening within 1 year of cardiac arrest. Old age, Hispanic ethnicity, and discharge disposition of home with out-patient services may be associated with a poor 1 year neurological recovery pattern after hospital discharge from cardiac arrest. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://ift.tt/29S62lw). Dr. Park received support for article research from the National Institutes of Health. Dr. Claassen received funding from SAGE Therapeutics. The remaining authors have disclosed that they do not have any potential conflicts of interest. For information regarding this article, E-mail: sa2512@columbia.edu Copyright © by 2017 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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