Post-intensive care syndrome in non-hospitalized cardiac arrest patients: a prospective observational cohort study
1. About half of patients with out-of-hospital cardiac arrest (OHCA) have evidence of post-intensive care syndrome (PICS) at 3 and 12 months after admission to intensive care, including alterations in their well- being physical, cognitive and psychological.
2. Risk factors for PICS for patients with OHCA include increased ICU length of stay, disease severity, intubation, poor discharge functionality, and job loss.
Level of evidence assessment: 2 (good)
Post-intensive care syndrome (PICS) refers to the physical, cognitive, and psychological harms that patients may face long-term after leaving the ICU. In particular, patients who experience out-of-hospital cardiac arrest (OHCA) have been associated with long-term negative impacts in these areas. Therefore, this study aimed to assess the prevalence and risk factors of PICS in adult survivors of OHCA. This cohort study was based in a single center in Switzerland and followed patients with OHCA 3 months and 12 months after admission to intensive care. The level of physical impairment was measured using the EuroQol questionnaire (EQ-5D-3L), the cognitive domain was measured using the Brain Performance Category (CPC) and the Modified Rankin Scale (mRS), and the psychological domain was measured using the Hospital Anxiety and Depression Scale (HADS) and Impact of Event Scale-Revised (IES-R). The study population consisted of 139 patients at 3-month follow-up and 110 patients at 12-month follow-up, with a median age of 62.8 years, a median ICU length of stay of 4 days, and a median 13 days hospitalization. . Results showed that at 3 months of follow-up, 49.6% of patients showed signs of PICS, with 36.7% demonstrating physical effects, 25.2% demonstrating cognitive effects and 12.9% demonstrating psychological effects. . Risk factors included intubation (OR 2.21, 95% CI 1.02-4.78, p = 0.043), length of ICU stay in days (OR 1.11, 95% CI 1.01-1.21, p = 0.022), loss of work during the follow-up period (OR 14.53, 95% CI 1.8-117.56, p = 0.012), and poor functionality at discharge, as measured by mRS (OR 4.35, 95% CI 1.7-11.1, p = 0.002) and CPC (OR 3.39, 95% CI 1.46-7.88, p = 0.005). At 12 months of follow-up, 47.3% showed signs of PICS, including 36.7% in the physical domain, 22.2% in the cognitive domain and 12.7% in the psychological domain. Risk factors included baseline disease severity as measured by the APACHE II score (OR 1.08, 95% CI 1.02-1.14, p = 0.008) and functionality at discharge, with a lower risk of PICS in patients not requiring rehabilitation (OR 0.31, 95% CI 0.12-0.82, p = 0.019). Overall, this study showed that PICS affects approximately half of patients with OHCA up to 1 year after ICU admission, demonstrating the importance of screening and identifying patients at risk for OHCA. pics, and connect them with relevant resources to support their physical, cognitive, and psychological recovery.
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