Abstract
Aim
Cardiac arrest (CA) survival has diverse psychosocial outcomes for both survivors
and their close family, with little known regarding long-term adjustment and recovery
experiences. We explored the psychological adjustment and experiential perspectives
of survivors and families in the second year after out-of-hospital cardiac arrest
(OHCA).
Methods
A prospective, mixed-methods study of adult OHCA survivors in Victoria, Australia
was conducted. Eighteen survivors and 12 family members completed semi-structured
interviews 14–19 months post-arrest. Survivors’ cognition, anxiety, depression and
post-traumatic stress symptoms were measured using a battery of psychological assessments.
A thematic content analysis approach was applied to qualitative interview data by
two independent investigators, with data coded and categorised into themes and sub-themes.
Results
Survivors’ cognition, depression, anxiety and post-traumatic stress symptoms were
not clinically elevated in the second year post-arrest. Subjective cognitive failures
were associated with increased anxiety but not with mental state. Depression was significantly
correlated with post-traumatic symptoms. Six primary themes emerged from survivors’
recovery stories, focused on: awakening and realisation, barriers to adjustment, psychosocial
difficulties, integration, protective factors and unmet needs. Family perspectives
revealed four primary themes focused on trauma exposure, survivor adjustment problems,
family impact, and areas for service improvement.
Conclusion
Survivors and their family members describe complex recovery journeys characterised
by a range of psychosocial adjustment challenges, which are not adequately captured
by common psychological measures. Post-arrest care systems are perceived by survivors
and their families as inadequate due to a lack of accurate information regarding post-arrest
sequalae, limited follow-up and inconsistent access to allied health care.
Keywords
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References
- Regional variation in the characteristics, incidence and outcomes of out-of-hospital cardiac arrest in Australia and New Zealand: results from the Aus-ROC Epistry.Resuscitation. 2018; 126: 49-57
- Sudden cardiac arrest survivorship: a scientific statement from the American Heart Association.Circulation. 2020; 141: e654-85
- Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest.Circulation. 2015; 131: 174-181
- Factors associated with return to work among survivors of out-of-hospital cardiac arrest.Resuscitation. 2019; (cited 13 October 2019, available from: http://www.sciencedirect.com/science/article/pii/S0300957219306136)
- The impact of cardiac arrest on the long-term wellbeing and caregiver burden of family caregivers: a prospective cohort study.Clin Rehabil. 2017; 31: 1267-1275
- Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review.Resuscitation. 2009; 80: 297-305
- Anxiety, depression, and PTSD following cardiac arrest: a systematic review of the literature.Resuscitation. 2013; 84: 873-877
- Trapped in a disrupted normality: survivors’ and partners’ experiences of life after a sudden cardiac arrest.Resuscitation. 2020; 147: 81-87
- Long-term quality of life of caregivers of cardiac arrest survivors and the impact of witnessing a cardiac event of a close relative.Resuscitation. 2018; 128: 198-203
- COSCA (core outcome set for cardiac arrest) in adults: an advisory statement from the International Liaison Committee on Resuscitation.Circulation. 2018; 137: e783-801
- Assessing health-related quality of life (HRQoL) in survivors of out-of-hospital cardiac arrest: a systematic review of patient-reported outcome measures.Resuscitation. 2018; 123: 22-37
- Moving from physical survival to psychologic recovery: a qualitative study of survivor perspectives on long-term outcome after sudden cardiac arrest.Resusc Plus. 2021; 5100055
- The experience of sudden cardiac arrest: becoming reawakened to life.J Cardiovasc Nurs. 2014; 13: 429-435
- A second chance at life: people’s lived experiences of surviving out-of-hospital cardiac arrest.Scand J Caring Sci. 2017; 31: 878-886
- “We don’t talk about his heart”: narrative sense-making and long-term readjustment among older out-of-hospital cardiac arrest survivors and their spouses.Resusc Plus. 2020; 3100024
- Using a cardiac arrest registry to measure the quality of emergency medical service care: decade of findings from the Victorian Ambulance Cardiac Arrest Registry.Circ Cardiovasc Qual Outcomes. 2015; 8: 56-66
- Structured interviews for the glasgow outcome scale and the extended glasgow outcome scale: guidelines for their use.J Neurotrauma. 1998; 15: 573-585
- EQ-5D: a measure of health status from the EuroQol Group.Ann Med. 2001; 33: 337-343
- “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- The cognitive failures questionnaire (CFQ) and its correlates.Br J Clin Psychol. 1982; 21: 1-16
- The hospital anxiety and depression scale.Acta Psychiatr Scand. 1983; 67: 361-370
- The impact of event scale—revised.Assessing psychological trauma and PTSD. The Guilford Press, New York, NY, US1997: 399-411
- IBM SPSS statistics for windows.IBM Corp, Armonk, NY2020
- Normative data for the hospital anxiety and depression scale.Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2015; 24: 391-398
- Psychometric validation of the english and french versions of the posttraumatic stress disorder checklist for DSM-5 (PCL-5).PLoS One. 2016; 11e0161645
- A purposeful approach to the constant comparative method in the analysis of qualitative interviews.Qual Quant. 2002; 36: 391-409
- Life after cardiac arrest: the importance of engaging with the ‘forgotten patient’.Resuscitation. 2018; 128: A1-2
- Care after resuscitation: implementation of the United Kingdom’s first dedicated multidisciplinary follow-up program for survivors of out-of-hospital cardiac arrest.Ther Hypothermia Temp Manag. 2019; (ther.2018.0048)
- Cardiac arrest and subsequent hospitalization-induced posttraumatic stress is associated with 1-year risk of major adverse cardiovascular events and all-cause mortality.Crit Care Med. 2019; 47: e502-5
- Is the Montreal Cognitive Assessment (MoCA) test better suited than the mini-mental state examination (MMSE) in mild cognitive impairment (MCI) detection among people aged over 60? Meta-analysis.Psychiatr Pol. 2016; 50: 1039-1052
- Underestimation of cognitive impairment by mini-mental state examination versus the Montreal Cognitive Assessment in patients with transient ischemic attack and stroke: a population-based study.Stroke. 2010; 41: 1290-1293
- Can MoCA and MMSE be interchangeable cognitive screening tools? A systematic review.Gerontologist. 2019; 59: e743-63
- Diagnostic accuracy of the Montreal Cognitive Assessment (MoCA) for cognitive screening in old age psychiatry: determining cutoff scores in clinical practice. Avoiding spectrum bias caused by healthy controls.Int J Geriatr Psychiatry. 2020; 35: 261-269
- European Resuscitation Council and European Society of Intensive Care Medicine guidelines for post-resuscitation care 2015.Resuscitation. 2015; 95: 202-222
- Comparison of three cognitive exams in cardiac arrest survivors.Resuscitation. 2017; 116: 98-104
- Validation of the Montreal Cognitive Assessment against the RBANS in a healthy South African cohort.South Afr J Psychiatry. 2018; 24 (cited 8 January 2021, Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6191746/)
- Lack of clinically relevant correlation between subjective and objective cognitive function in ICU survivors: a prospective 12-month follow-up study.Crit Care. 2019; 23: 253
- Assessment of neurocognitive function after cardiac arrest.Curr Opin Crit Care. 2019; 25: 234-239
- Psychometric properties of the cognitive failures questionnaire.Ergonomics. 2013; 56: 1515-1524
- Self-reported cognitive failures and neurotic symptomalogy.Personal Individ Differ. 1996; 20: 715-724
- Self-reported cognitive failures in everyday life: a closer look at their relation to personality and cognitive performance.Assessment. 2020; 27: 982-995
- Diagnostic and statistical manual of mental disorders: DSM 5.American Psychiatric Association, Arlington, VA2013
Article info
Publication history
Published online: July 06, 2021
Accepted:
June 25,
2021
Received in revised form:
June 11,
2021
Received:
February 6,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
