Long term follow up after CA
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1 Long term follow up after CA Lund Espen Rostrup Nakstad Oslo University Hospital, Norway handout - page 1 of 9
2 handout - page 2 of 9 NORCAST Unexpected Cardiac Arrest Europe: / year Sans S et al. Eur Heart J 1997;18: USA: / year American Heart Association;2005 (update). 80% CA at home (> 90% fatal) Callans DJ.N Engl J Med 2004;351: Albert CM, Circulation 2003;107: Norway: / year OUS: 200 OHCA / year What happens to these?
3 The Norwegian Cardiorespiratory Arrest Study - NORCAST Combined clinical-neurological, neurophysiological, neuroradiological and biochemical markers in prognostication after cardiac and/or respiratory arrest Clinical Trials ID - NCT REK S-O A - Reg 2010/1116a Elisabeth Paus Miriam Øijordsbakken Jens Petter Berg Anne-Marie Trøseid Ingebjørg Seljeflot Harald Arnesen Sissel Åkra Vibeke Bratseth Geir Ø. Andersen Jan Eritsland Arild Mangschau Anders Opdahl Pål Solberg Helle Holte Ingrid Harg Siw Trudvang Henrik Stær-Jensen Tomas Drægni Fridtjof Heyerdahl Kjetil Sunde Espen R. Nakstad Dag Jacobsen Sigrid Beitland Ingrid Os John Aage Wilson Dep. Neurophysiology Christofer Lundqvist Antje Reichenbach Lars Holger Alteheld Julia Henriksen Till Schellhorn Per Hjalmar Nakstad Andres Server Alonso handout - page 3 of 9
4 Patient categories * (pre-hosp data) Cause of death * 1) Ischemic cardiac arrest 2) Arrhythmic cardiac arrest 3) Hypoxic cardiac arrest 4) Respiratory arrest / severe hypoxia 5) Other non-traumatic cause of coma * Concidered by NORCAST Study Committee 1) Cardiac death (certain) 2) Cerebral death (certain) Elisabeth Paus Miriam Øijordsbakken Jens Petter Berg Anne-Marie Trøseid Ingebjørg Seljeflot Harald Arnesen Sissel Åkra Vibeke Bratseth Geir Ø. Andersen Jan Eritsland Arild Mangschau Anders Opdahl Pål Solberg Helle Holte 3) Cardiac death (most likely) Ingrid Harg 4) Cerebral death (most likely) Siw Trudvang Henrik Stær-Jensen Tomas Drægni 5) Other cause (MOF, sepsis..) Fridtjof Heyerdahl Kjetil Sunde Espen R. Nakstad Dag Jacobsen Sigrid Beitland Ingrid Os John Aage Wilson Dep. Neurophysiology Christofer Lundqvist Antje Reichenbach Lars Holger Alteheld Julia Henriksen Till Schellhorn Per Hjalmar Nakstad Andres Server Alonso handout - page 4 of 9
5 handout - page 5 of 9 NORCAST In-hospital; prognostic markers - clinical, - neurological, - neurophysiological, - neuroradiological, - biochemical markers
6 handout - page 6 of 9 NORCAST Post-hospital treatment and follow-up 0-6 months Rehab (local/ regional institution); 20-40% General Practitioner; % Dep. Cardiology (ICD patients) 100% Psychiatrist/ Psycologist; < 10% Neurologist; < 5% ( tentative numbers based on patient reports)
7 Post-hospital follow-up (study patients) at 6 months (+/- 14 days) Standardised Clinical-Neurological Exam CPC and Barthel Index score COGNISTAT (The Neurobehavioral Cognitive Status Examination ) Patients and family questionnaire; excerpts from - SF-36 - EuroQoL-5D - IEC - HADS - SIP-68 and CIQ handout - page 7 of 9
8 6-month follow-up CPC 1 Good performance CPC 2 moderate disability CPC 3 severe disability CPC 4 coma Vegetative Patient characteristics (random order) a) memory, multi-tasking capasity [neurologist] b) fatigue, anxiety [patient] c) minor personality change [family] d) family role/ responsibilities changed [family] e) depression (sofa-syndrome) [patient/family] f) reduced emotional/ behavioural control [all] General concerns (raised by most patients): - Drivers licence? - Medication/side effects? - Risk of new CA? - Is it safe to work? Safar P. Resuscitation after Brain Ischemia, in Grenvik A and Safar P Eds: Brain Failure and Resuscitation, Churchill Livingstone, New York, 1981; handout - page 8 of 9
9 handout - page 9 of 9 NORCAST Lessons learned Resuscitation : - time is nothing, quality is everything 6 mth follow-up: - highly appreciated - strongly needed - by competent hospital physicians, not only GPs.
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