Outcomes after OHCA: insights into survival, neurological function, and quality of life

Background Out-of-Hospital Cardiac Arrest (OHCA) remains a major global health challenge, significantly contributing to mortality and morbidity. Despite advances in pre-hospital management, OHCA is often associated with poor neurological outcomes and high mortality. In Portugal, there is limited information regarding post-OHCA survival, quality of life (QoL), and functional status. This study aims to address this gap by analyzing these outcomes. Aim To evaluate survival, QoL, and performance status after OHCA. Methods This retrospective, single-centre study included consecutive adult OHCA patients admitted to an Intensive Care Unit (ICU) from January 2017 to December 2019. Data was collected from clinical records (pre-hospital, emergency room, ICU, and post-discharge) and telephone interviews with survivors. QoL was assessed using the Cerebral Performance Category (CPC) scale and EQ-5D-5L questionnaire, while performance status was measured with the Eastern Cooperative Oncology Group (ECOG) scale. Results Of 72 patients (mean age 61 ± 15 years), 26 (36.1%) survived to hospital discharge. Most OHCA events (84.7%) were witnessed, with 70.8% receiving basic life support (BLS) and 22.1% BLS with an automated external defibrillator (AED). The most common OHCA location was at home (43.1%), and cardiac causes accounted for 68.1% of cases. A shockable rhythm was present in 51.4%. Higher Glasgow Coma Scale (GCS) scores after return of spontaneous circulation (ROSC) were associated with improved ICU (p < 0.001, V-Cramer = 0.565) and hospital (p < 0.001, V-Cramer = 0.625) survival rates. At hospital discharge, 65% of survivors had a CPC score of 1 or 2. Five years later, 19 patients were alive, with 92.5% of interviewed survivors maintaining CPC scores of 1 or 2. Most survivors (50%) reported "no problems" in EQ-5D-5L domains. However, declines were noted in "Mobility," "Usual Activities," and "Anxiety/Depression." The EQ-5D-5L index was 0.903 (SD = 0.193). Regarding performance status, 64.3% of survivors were able to perform at least sedentary work (ECOG score ≤ 1). Conclusions A total of 36.1% of OHCA patients survived to hospital discharge, with higher GCS scores after ROSC linked to improved outcomes. Long-term follow-up revealed that most survivors reported good QoL and functional performance.