The Prognosis After Cardiac Arrest: Evidence on the Short- and Long-Term Course

Each year, approximately 84 out of 100 000 individuals in Europe sustain a cardiac arrest; many die or suffer long-term neurological injury. Early prognostication can be of assistance for treatment planning and for the holding of evidencebased discussions with these patients' families to make decisions about treatment.

This narrative review is based on pertinent guidelines and on publications retrieved by a selective search in Medline/ PubMed.

The survival rate of in-hospital cardiac arrest (IHCA) is 15-34%, that of out-of-hospital cardiac arrest (OHCA) approximately 10%. Survivors have an elevated risk of severe neurological injury: 22.9% (IHCA) and 67.7% (OHCA) go on to die in an intensive care unit of severe brain damage. Among those who are still alive one year after cardiac arrest, 83.3% have a good neurological outcome (cerebral performance category [CPC] score, 1-2), although many suffer from post-intensive care syndrome. Early prognostication is generally difficult, and an initial assessment can often only be made 72 hours or more after the event, on the basis of multimodal diagnostic testing. Risk models and biomarkers are available as aids to early prognostication but have not yet come into broad use.

Many successfully resuscitated patients die shortly thereafter. Those who survive for one year generally have good neurological function. Early prognostication is of fundamental importance for decision-making about continuing treatment or whether resuscitation should be attempted again in the case of a second arrest. Physicians communicating with the affected patients and their families should also be mindful of the commonly associated emotional stress.