Long-term disability level of 1-month survivors after out-of-hospital cardiac arrest: a nationwide cohort study in Korea using data from 2009 to 2018
1Department of Emergency Medicine, Ulsan University College of Medicine, Asan Medical Center, 05505 Seoul, Republic of Korea
2Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, 05505 Seoul, Republic of Korea
Submitted: 08 December 2021 Accepted: 06 January 2022
Online publish date: 24 February 2022
Recent guidelines identified recovery from cardiac arrest as an additional link in the chain of survival. However, data on the disability level and long-term survivorship in such patients are limited. We aimed to determine the long-term disability level, including disability type and severity, in patients with out-of-hospital cardiac arrest (OHCA) 1 month after discharge. This nationwide observational study used data from the National Health Insurance Service of Korea. We included adult OHCA patients who presented to the emergency departments (ED) of all hospitals in Korea between 2009 and 2018. The main outcome was disability level between 1 month after discharge and the 2-year follow-up. The average disability level was divided into six grades: most severe (grade 1) to mild (grade 6). Among 224,520 OHCA patients, 25,598 (11.4%) survived at 30 days. After excluding 3143 patients with a follow-up less than 2 years, 22,455 patients were included. Newly-developed disabilities were observed in 2664 patients (11.9%) and were more frequent in 1-year survivors than non-survivors (16.7% vs. 4.4%, p < 0.01). The most common type of disability was encephalopathic (54.2%), followed by renal (16.1%), physical (10.5%), and cardiac (4.2%) disabilities. Grade 1 disability was most frequent, followed by grade 2 and 3 (45.7%, 23.5%, 10.9%, respectively). Among patients who survived at 30 days after OHCA, 11.9% developed disabilities, including encephalopathic, physical, renal, and cardiac disabilities. Physicians should be aware of the risk of these disabilities and efforts to treat these disabilities in OHCA survivors should be increased.
Cardiac arrest; Long-term disability; Disability level; Population-based study
Sang-Min Kim,Youn-Jung Kim,Ye-Jee Kim,Won-Young Kim. Long-term disability level of 1-month survivors after out-of-hospital cardiac arrest: a nationwide cohort study in Korea using data from 2009 to 2018. Signa Vitae. 2022.doi:10.22514/sv.2022.014.
 Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation. 2010; 81: 1479–1487.
 Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, et al. European resuscitation council and European society of intensive care medicine guidelines 2021: post-resuscitation care. Resuscitation. 2021; 161: 220–269.
 Kim YJ, Ahn S, Sohn CH, Seo D, Lee Y, Lee JH, et al. Long-term neurological outcomes in patients after out-of-hospital cardiac arrest. Resuscitation. 2016; 101: 1–5.
 Scarpino M, Lolli F, Lanzo G, Carrai R, Spalletti M, Valzania F, et al. Neurophysiology and neuroimaging accurately predict poor neurological outcome within 24 hours after cardiac arrest: the ProNeCA prospective multicentre prognostication study. Resuscitation. 2019; 143: 115–123.
 Juan E, De Lucia M, Beaud V, Oddo M, Rusca M, Viceic D, et al. How do you Feel? subjective perception of recovery as a reliable surrogate of cognitive and functional outcome in cardiac arrest survivors. Critical Care Medicine. 2018; 46: e286–e293.
 Wilder Schaaf KP, Artman LK, Peberdy MA, Walker WC, Ornato JP, Gossip MR, et al. Anxiety, depression, and PTSD following cardiac arrest: a systematic review of the literature. Resuscitation. 2013; 84: 873–877.
 Lilja G, Nielsen N, Friberg H, Horn J, Kjaergaard J, Nilsson F, et al. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33◦C versus 36◦C. Circulation. 2015; 131: 1340–1349.
 Panchal AR, Bartos JA, Cabañas JG, Donnino MW, Drennan IR., Hirsch KG et al. Part 3: adult basic and advanced life support: 2020 American heart association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2020; 142: S366–S468.
 Sawyer KN. Reintegration & recovery after surviving cardiac arrest: learning from the VACAR registry. Resuscitation. 2020; 146: 255–257.
 Larsson IM, Wallin E, Rubertsson S, Kristoferzon ML. Relatives’ experiences during the next of kin’s hospital stay after surviving cardiac arrest and therapeutic hypothermia. European Journal of Cardiovascular Nursing. 2013; 12: 353–359.
 Kim JA, Yoon S, Kim LY, Kim DS. Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) data as a resource for health research: strengths, limitations, applications, and strategies for optimal use of HIRA data. Journal of Korean Medical Science. 2017; 32: 718–728.
 Cheol Seong S, Kim YY, Khang YH, et al. data resource profile: the national health information database of the national health insurance service in South Korea. International Journal of Epidemiology. 2017; 46: 799–800.
 Kim K. Disability rating system reform in Korea: focusing on improving of the service delivery system for people with disabilities. Journal of Social Service Research. 2019; 45: 1–11.
 Kim WH, Park YG, Shin HI, Im SH. The world report on disability and recent developments in South Korea. American Journal of Physical Medicine & Rehabilitation. 2014; 93: S58–S62.
 Bahk J, Kang HY, Khang YH. The life expectancy gap between registered disabled and non-disabled people in korea from 2004 to 2017. International Journal of Environmental Research and Public Health. 2019; 16: 2593.
 Smith K, Andrew E, Lijovic M, Nehme Z, Bernard S. Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest. Circulation. 2015; 131: 174–181.
 Chocron R, Fahrenbruch C, Yin L, Guan S, Drucker C, Shin J, et al. Association between functional status at hospital discharge and long-term survival after out-of-hospital-cardiac-arrest. Resuscitation. 2021; 164: 30–37.
 Hermans G, Van Mechelen H, Clerckx B, Vanhullebusch T, Mesotten D, Wilmer A, et al. Acute outcomes and 1-year mortality of intensive care unit-acquired weakness. a cohort study and propensity-matched analysis. American Journal of Respiratory and Critical Care Medicine. 2014; 190: 410–420.
 Sharshar T, Bastuji-Garin S, Stevens RD, Durand MC, Malissin I, Rodriguez P, et al. Presence and severity of intensive care unit-acquired paresis at time of awakening are associated with increased intensive care unit and hospital mortality. Critical Care Medicine. 2009; 37: 3047–3053.
 Wieske L, Dettling-Ihnenfeldt DS, Verhamme C, Nollet F, van Schaik IN, Schultz MJ, et al. Impact of ICU-acquired weakness on post-ICU physical functioning: a follow-up study. Critical Care. 2015; 19: 196.
 Petzinka VN, Endisch C, Streitberger KJ, Salih F, Ploner CJ, Storm C, et al. Unresponsive wakefulness or coma after cardiac arrest—a long-term follow-up study. Resuscitation. 2018; 131: 121-127.
 Peskine A, Cariou A, Hajage D, Deye N, Guérot E, Dres M, et al. Long-term disabilities of survivors of out-of-hospital cardiac arrest: the hanox study. Chest. 2021; 159: 699–711.
 Moulaert VR, van Heugten CM, Winkens B, Bakx WG, de Krom MC, Gorgels TP, et al. Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial. International Journal of Cardiology. 2015; 193: 8–16.
 Moulaert VR, Goossens M, Heijnders IL, Verbunt JA, Heugten CM. Early neurologically focused follow-up after cardiac arrest is cost-effective: a trial-based economic evaluation. Resuscitation. 2016; 106: 30–36.
 Kim YM, Jeung KW, Kim WY, Park YS, Oh JS, You YH, et al. 2020 Korean guidelines for cardiopulmonary resuscitation. part 5. Post-cardiac arrest care. Clinical and Experimental Emergency Medicine. 2021; 8: S41–S64.
 World Health Organization. International classification of functioning, disability, and Health: children & youth version: ICF-CY. World Health Organization: Geneva. 2007.
 Jeon B, Noguchi H, Kwon S, Ito T, Tamiya N. Disability, poverty, and role of the basic livelihood security system on health services utilization among the elderly in South Korea. Social Science & Medicine. 2017; 178: 175–183.
 Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral performance category and long-term prognosis following out-of-hospital cardiac arrest. Critical Care Medicine. 2013; 41: 1252–1257.
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