Organ support therapy in the intensive care unit and return to work in out-of-hospital cardiac arrest survivors: A nationwide cohort study

TY - JOUR

T1 - Organ support therapy in the intensive care unit and return to work in out-of-hospital cardiac arrest survivors

T2 - A nationwide cohort study

AU - Riddersholm, Signe

AU - Kragholm, Kristian

AU - Mortensen, Rikke Nørmark

AU - Hansen, Steen Moller

AU - Wissenberg, Mads

AU - Lippert, Freddy K

AU - Torp-Pedersen, Christian

AU - Christiansen, Christian F

AU - Rasmussen, Bodil Steen

N1 - Copyright © 2018 Elsevier B.V. All rights reserved.

PY - 2018/4

Y1 - 2018/4

N2 - AIM: With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work.METHODS: This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models.RESULTS: Of 1087 30-day survivors, 212 (19.5%) were treated in an ICU with 0-1 types of organ support, 494 (45.4%) with support of two organs, 26 (2.4%) with support of three organs and 355 (32.7%) were not admitted to an ICU. Return to work increased with decreasing number of organs supported, from 53.8% (95% CI: 49.5-70.1%) in patients treated with both RRT, cardiovascular support and mechanical ventilation to 88.5% (95% CI: 85.1-91.8%) in non-ICU-patients. In 732 ICU-patients, ICU-patients with support of 3 organs had significantly lower adjusted hazard ratios (HR) of returning to work (0.50 [95% CI: 0.30-0.85] compared to ICU-patients with support of 0-1 organ. The corresponding HR was 0.48 [95% CI: 0.30-0.78] for RRT alone.CONCLUSIONS: In 30-day survivors of OHCA, number of organ support therapies and in particular need of RRT were associated with reduced rate of return to work, although more than half of these latter patients still returned to work.

AB - AIM: With increased survival after out-of-hospital cardiac arrest (OHCA), impact of the post-resuscitation course has become important. Among 30-day OHCA survivors, we investigated associations between organ support therapy in the Intensive Care Unit (ICU) and return to work.METHODS: This Danish nationwide cohort-study included 30-day-OHCA-survivors who were employed prior to arrest. We linked OHCA data to information on in-hospital care and return to work. For patients admitted to an ICU and based on renal replacement therapy (RRT), cardiovascular support and mechanical ventilation, we assessed the prognostic value of organ support therapies in multivariable Cox regression models.RESULTS: Of 1087 30-day survivors, 212 (19.5%) were treated in an ICU with 0-1 types of organ support, 494 (45.4%) with support of two organs, 26 (2.4%) with support of three organs and 355 (32.7%) were not admitted to an ICU. Return to work increased with decreasing number of organs supported, from 53.8% (95% CI: 49.5-70.1%) in patients treated with both RRT, cardiovascular support and mechanical ventilation to 88.5% (95% CI: 85.1-91.8%) in non-ICU-patients. In 732 ICU-patients, ICU-patients with support of 3 organs had significantly lower adjusted hazard ratios (HR) of returning to work (0.50 [95% CI: 0.30-0.85] compared to ICU-patients with support of 0-1 organ. The corresponding HR was 0.48 [95% CI: 0.30-0.78] for RRT alone.CONCLUSIONS: In 30-day survivors of OHCA, number of organ support therapies and in particular need of RRT were associated with reduced rate of return to work, although more than half of these latter patients still returned to work.

KW - Cardiopulmonary Resuscitation/adverse effects

KW - Cohort Studies

KW - Female

KW - Humans

KW - Intensive Care Units/statistics & numerical data

KW - Length of Stay/statistics & numerical data

KW - Male

KW - Out-of-Hospital Cardiac Arrest/therapy

KW - Proportional Hazards Models

KW - Registries

KW - Renal Replacement Therapy/adverse effects

KW - Respiration, Artificial/adverse effects

KW - Return to Work/statistics & numerical data

KW - Survivors/statistics & numerical data

KW - Time Factors

U2 - 10.1016/j.resuscitation.2018.01.001

DO - 10.1016/j.resuscitation.2018.01.001

M3 - Journal article

C2 - 29337172

SN - 0300-9572

VL - 125

SP - 126

EP - 134

JO - Resuscitation

JF - Resuscitation

ER -