Keywords
Survival with good neurological outcome after an out-of-hospital cardiac arrest (OHCA) has increased in the last fifteen years, [
[1]
] but, despite the quality of life of cardiac arrest survivors is generally acceptable, the incidence of depression after the event is not negligible, varying from 10% to 50% [[2]
]. This fact is extremely important considering that depression negatively affect the quality of life and the outcomes [[3]
]. However, available data refers mostly to Northern Europe area with a lack of data on Southern Europe people and this is not to be underestimated considering that the incidence of depressive disorders vary across different countries and, moreover, there are only few data about any correlation between OHCA characteristics and the onset of later depression [[4]
].We wanted to evaluate the incidence of depression in a population of Italian OHCA survivors and we wanted to verify whether some characteristics of the event could be associated to depression or not. We considered, through the Pavia Province Cardiac Arrest Registry (Pavia CARe), all the patients who suffered an OHCA in Pavia Province between October 2014 and September 2016 and who were discharged alive with CPC 1 or 2. A clinical psychologist telephone-administered PHQ-9 questionnaire focused to the first two weeks after the patient was discharged at home. The PHQ-9 questionnaire score ranges from 0 to 27 with cut points of 5, 10, 15, and 20 representing mild, moderate, moderately severe, and severe depression, respectively.
We were able to administer the PHQ-9 questionnaire to 32 patients with baseline characteristics presented in Table 1. Among these patients, 6 (18.7%) showed a PHQ-9 score between 5 and 9, and 6 (18.7%) reached a PHQ-9 score ≥10. The percentage of patients referred to the psychologist during hospitalization or at the hospital discharge was quite low: 33% in the first group and 50% in the second one.
Table 1Baseline characteristics of the study population.
| Age | Male | Etiology OHCA | Residential Location OHCA | OHCA Witnessed | CPR by bystander (in witnessed by bystander) | First rythm shockable | Shock by bystander | Minutes from OHCA to ROSC | Admission in Intensive Care Unit | STEMI cause of OHCA | Days of hospitalization |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 62 ± 14 | 78.1% | 100% Medical | 62.5% | 46.8% EMS; 53.2% bystander | 88% | 96.9% | 9.4% | 21 ± 23 | 65.6% | 68.7% | 15 ± 11 |
Regarding the OHCA characteristics and the onset of depression, neither the time to ROSC (rho 0.15; p = 0.38) nor the duration of hospitalization (rho 0.29; p = 0.11) were found to be correlated to the PHQ-9 score. A weak but statistically significant reverse correlation was found between PHQ-9 score and age (rho −0.35; p = 0.04). Moreover, OHCA characteristics (OHCA location, OHCA witnessed status, bystander CPR, use of AED by bystander, admission to ICU and a STEMI cause of OHCA) were similar when comparing patients with a PHQ–9 ≥5 to those with a PHQ–9 <5 and patients with a PHQ–9 ≥9 to those with a PHQ-9 score <9.
Our findings confirm that depression in OHCA survivors is not negligible also in a Southern Europe population. Nevertheless, only a minority of patients with PHQ-9 score suggestive for depression were referred to a specialist during hospitalization or at hospital discharge. Moreover, we did not find any correlation between OHCA characteristics and the PHQ-9 values: this may be due to the fact that cardiac arrest being a sort of experience of death may induce depression more than other factors which may be important in other contest. We think that our results point out two critical issues: the first one is that, despite 2015 ERC Guidelines for post-resuscitation care [
[5]
], clinicians and cardiologists do not address the brain-related consequences of cardiac arrest as the cardiac ones, at least in our region; the second one is that even after a case of a short and quickly treated cardiac arrest, depression may come out and this aspect could be really useful to who taking care of cardiac arrest survivors. So, we think that clinicians and cardiologists should always screen for depression to improve its recognition and treatment.- Nolan J.P.
- Soar J.
- Cariou A.
- Cronberg T.
- Moulaert V.R.
- Deakin C.D.
- et al.
European rsuscitation council and European society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation 2015.
Resuscitation. 2015; 95: 202-222
Conflict of interest
None.
References
- EuReCa ONE Collaborators. EuReCa ONE-27 Nations, ONE, Europe, ONE Registry: a prospective one month analysis of out-of-hospital cardiac arrest outcomes in 27 countries in Europe.Resuscitation. 2016; 105: 188-195
- Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest.Resuscitation. 2009; 80: 517-522
- Determinants of quality of life in survivors of cardiac arrest.J Rehabil Med. 2010; 42: 553-558
- Life after death: posttraumatic stress disorder in survivors of cardiac arrest–prevalence, associated factors, and the influence of sedation and analgesia.Crit Care Med. 2004; 32: 378-383
- European rsuscitation council and European society of intensive care medicine guidelines for post-resuscitation care 2015: section 5 of the European resuscitation council guidelines for resuscitation 2015.Resuscitation. 2015; 95: 202-222
Article info
Publication history
Published online: March 16, 2018
Received:
March 14,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
