From the Guidelines
The prognosis following cardiopulmonary arrest is generally guarded, with overall survival to hospital discharge ranging from 10-30% for out-of-hospital arrests and 15-40% for in-hospital arrests, and neurological recovery can continue for up to 6-12 months post-arrest. Patients who receive immediate high-quality CPR and early defibrillation (if indicated) have better outcomes 1. Key factors influencing prognosis include the duration of arrest, time to initiation of CPR, underlying cause, and post-resuscitation care.
Post-Resuscitation Care
Targeted temperature management (TTM) at 32-36°C for 24 hours is recommended for comatose adult patients with return of spontaneous circulation (ROSC) after cardiac arrest 1. Neurological assessment should be delayed until at least 72 hours after return to normothermia and off sedation, as early prognostication can be unreliable.
Prognostic Indicators
Key prognostic indicators include:
- Pupillary light reflexes
- Corneal reflexes
- Absence of N20 waves on somatosensory evoked potentials
- Status myoclonus
- Neuron-specific enolase levels
- Brain imaging findings Addressing the underlying cause of arrest (such as coronary artery disease) is crucial for preventing recurrence and improving long-term survival 1. Long-term rehabilitation and support are essential components of care, as neurological recovery can continue for up to 6-12 months post-arrest.
From the Research
Prognosis Following Cardiopulmonary Arrest
The prognosis following cardiopulmonary arrest is generally poor, with a low survival rate and a high risk of neurological injury.
- The survival rate of in-hospital cardiac arrest (IHCA) is 15-34%, while that of out-of-hospital cardiac arrest (OHCA) is approximately 10% 2.
- Among survivors, 22.9% (IHCA) and 67.7% (OHCA) go on to die in an intensive care unit due to severe brain damage 2.
- Early prognostication is difficult and is often only possible 72 hours or more after the event, based on multimodal diagnostic testing 2.
Factors Affecting Prognosis
Several factors can affect the prognosis after cardiopulmonary arrest, including:
- Prearrest factors, such as the presence or absence of a shockable rhythm 3.
- Intra-arrest factors, such as the partial pressure of end-tidal CO2 and the presence of cardiac standstill on ultrasound 3.
- Postarrest factors, including early outcome measures and a comprehensive algorithmic approach to predicting neurologic outcome 3.
- Age, with patients over 70 years old typically having a poorer prognosis 4.
- The duration of cardiopulmonary resuscitation (CPR), with longer durations associated with a lower probability of survival 5.
Neurological Outcome
The neurological outcome after cardiopulmonary arrest is a major concern, with many survivors experiencing severe neurological injury.
- Only 5% of patients who are unconscious 48 hours after arrest will have a full neurologic recovery 4.
- Among those who survive for one year after cardiac arrest, 83.3% have a good neurological outcome (cerebral performance category [CPC] score, 1-2) 2.
- However, many survivors suffer from post-intensive care syndrome, which can have a significant impact on their quality of life 2.
Decision-Making and Treatment
Decision-making and treatment after cardiopulmonary arrest are critical, and early prognostication is essential for guiding treatment decisions.
- Risk models and biomarkers are available to aid in early prognostication, but have not yet come into broad use 2.
- Physicians communicating with patients and their families should be mindful of the emotional stress associated with cardiopulmonary arrest and its aftermath 2.
- The duration of CPR and the likelihood of survival should be carefully considered when making decisions about continuing treatment or attempting resuscitation again in the case of a second arrest 5.