Review articleSystematic review of quality of life and other patient-centred outcomes after cardiac arrest survival☆
Introduction
The major part of the scientific literature underpinning resuscitation after cardiac arrest has focussed on survival, and much of this short-term survival. Recent developments in post resuscitation care have demonstrated improvements in short term survival, but with the potential for very substantial associated health and social care costs.1, 2 Large sums of money have been invested in providing training, equipment and personnel to maximise the chances of survival for patients experiencing a cardiac arrest.
Concern has been expressed that in spite of this investment, survivors of cardiac arrests go on to experience a diminished existence, associated with an unacceptable quality of life, and that this would thus not justify the efforts and costs involved.3
Thus, the aim of this systematic review was to determine whether the quality of life for patients who have experienced a cardiac arrest and survived is acceptable.
The research question addressed was: in cardiac arrest patients (in hospital and prehospital) does resuscitation produce a good Quality of Life (QoL) for survivors after discharge from the hospital?
Section snippets
Methods
This review was conducted in accordance with the International Liaison Committee on Resuscitation (ILCOR) 2010 evidence evaluation process. Expert review of the search strategy and findings were conducted by the worksheet evaluation experts.
Results
The primary Embase search returned 5167 articles. The Cochrane Database of Systematic Reviews and the Central Register of Clinical Trials did not return any relevant articles. The American Heart Association resuscitation endnote library search returned 77 articles that were all duplicates of the primary search. Pubmed returned 1078 articles, only one of which was not a duplicate of primary search. 192 articles had their abstracts reviewed in detail for relevance; 122 articles were discarded,
Discussion
There was no overwhelming evidence from this review that resuscitating people after cardiac arrest led to a large pool of patients that experienced an unbearably poor quality of life (QoL). The majority of studies concluded that the provision of resuscitation after cardiac arrest does provide patients with a good quality of life after discharge from hospital.
This review also demonstrated a remarkable heterogeneity of methodology amongst studies assessing QoL in cardiac arrest survivors, with
Authors conclusions and recommendations
This review provides good evidence that survivors of cardiac arrest have an acceptable or good quality of life, although this is not necessarily the same quality of life that they experienced prior to their cardiac arrest.
The review process has demonstrated a requirement for consensus development with regard to quality of life and patient centred outcome assessment after cardiac arrest. We would suggest that urgent attention be given to developing consensus in the following areas, which could
Disclaimer
This review includes information on resuscitation questions developed through the C2010 Consensus on Science and Treatment Recommendations process, managed by the International Liaison Committee on Resuscitation (http://www.americanheart.org/ILCOR). The questions were developed by ILCOR Task Forces, using strict conflict of interest guidelines. In general, each question was assigned to two experts to complete a detailed structured review of the literature, and complete a detailed worksheet.
Conflict of interest statement
Vanessa Elliott and David L. Rodgers have no conflicts of interest to declare.
Stephen Brett receives a research grant from Carefusion for a technology evaluation project, around wireless monitoring. I have received a speakers honorarium from Pfizer (lecture on pulmonary hypertension), and consultancy fees from Baxter (beta blockers) and Pfizer (anti-fungals).
Acknowledgement
SJB wishes to acknowledge the support of the UK NIHR Biomedical Research Centre Scheme.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.10.030.