Quality of life and functional outcomes after in-hospital cardiopulmonary resuscitation. A systematic review

Abstract

Aim

Our aim was to determine the association of cardiopulmonary resuscitation (CPR) for in hospital cardiac arrest (IHCA) with quality of life after discharge.

Methods

We performed a systematic review using available databases for studies that measured any quality-of-life or functional outcome both before and after CPR for IHCA. All screening and data abstraction was performed in duplicate.

Results

We screened 10,927 records and included 24 papers representing 20 unique studies. Fifteen studies measured Cerebral Performance Category. Survival ranged from 11.8% to 39.5%. The risk of impaired cerebral function after discharged ranged from −16.1% (lower risk) to 44.7% increased risk of poor cerebral function after surviving to discharge. Four studies measured discharge to an institutional environment finding that the risk was increased by 18.2–72.2% among survivors. One study measured EQ-5D and found no difference pre and post CPR. One study measured performance of activities of daily living finding that survivors needed assistance with more activities after discharge.

Conclusion

Our review is limited by the lack of adjustment for confounders, including the baseline level of each outcome, in all included studies. Therefore, although risk for most outcomes was increased after discharge vs pre-admission we cannot be certain if this is a causal relationship.

Introduction

Cardiopulmonary resuscitation (CPR) is a treatment provided to restart the heart in the event of a cardiac arrest. Many hospitals require that patients’ wishes regarding the receipt or non-receipt of CPR be documented in the medical record shortly after admission. However, helping patients arrive at the best decision for themselves can be difficult. A high-quality decision requires accurate understanding of the harms and benefits of each option and reflection on which harms and benefits matter most to the individual. Unfortunately, optimistic depictions of CPR in the media lead to unrealistic expectations and accurate data about functional and quality of life outcomes is lacking.1., 2.

The probability of surviving in-hospital cardiac arrests (IHCA) has been well studied but much less is known about survivor’s quality-of-life (QoL) and functioning.3., 4. Many patients with chronic diseases and multimorbidity are already living with physical or cognitive disabilities and almost half consider various states of disability, that may occur after CPR, as worse than death.⁵ Patients and physicians need accurate information about the QoL after IHCA to help them decide if CPR should be included in a care plan. Two critical pieces of information can help inform the decision are: (1) What is the probability that I will survive and have an acceptable QoL and function? and (2) If I survive, what is the probability of having a good QoL and function? There are no systematic reviews evaluating QoL or function as an outcome after in-hospital CPR that provide these probabilities. Therefore, we performed a systematic review of adult patients' QoL and function after CPR for IHCA.