Health-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial

Anina F van de Koolwijk; Thijs S R Delnoij; Martje M Suverein; Brigitte A B Essers; Renicus C Hermanides; Luuk C Otterspoor; Carlos V Elzo Kraemer; Alexander P J Vlaar; Joris J van der Heijden; Erik Scholten; Corstiaan A den Uil; Dinis Dos Reis Miranda; Sakir Akin; Jesse de Metz; Iwan C C van der Horst; Bjorn Winkens; Jos G Maessen; Roberto Lorusso; Marcel C G van de Poll; INCEPTION-investigators

doi:10.1016/j.resplu.2024.100669

Health-related quality of life one year after refractory cardiac arrest treated with conventional or extracorporeal CPR; a secondary analysis of the INCEPTION-trial

Resusc Plus. 2024 May 30:19:100669. doi: 10.1016/j.resplu.2024.100669. eCollection 2024 Sep.

Authors

Anina F van de Koolwijk¹, Thijs S R Delnoij^{1

2}, Martje M Suverein¹, Brigitte A B Essers³, Renicus C Hermanides⁴, Luuk C Otterspoor⁵, Carlos V Elzo Kraemer⁶, Alexander P J Vlaar⁷, Joris J van der Heijden⁸, Erik Scholten⁹, Corstiaan A den Uil^{10

11

12}, Dinis Dos Reis Miranda¹⁰, Sakir Akin¹³, Jesse de Metz¹⁴, Iwan C C van der Horst^{1

15}, Bjorn Winkens^{16

17}, Jos G Maessen¹⁸, Roberto Lorusso¹⁸, Marcel C G van de Poll^{1

19}; INCEPTION-investigators

Affiliations

¹ Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands.
² Department of Cardiology, Maastricht University Medical Centre+, Maastricht University, Maastricht, The Netherlands.
³ Department of Clinical Epidemiology and Medical Technical Assessment, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands.
⁴ Department of Cardiology, Isala Clinics, Zwolle, The Netherlands.
⁵ Department of Intensive Care, Catharina Hospital, Eindhoven, The Netherlands.
⁶ Department of Intensive Care, Leiden University Medical Center, Leiden University, Leiden, The Netherlands.
⁷ Department of Intensive Care, Amsterdam University Medical Center Location AMC, University, Amsterdam, Amsterdam, The Netherlands.
⁸ Department of Intensive Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
⁹ Department of Intensive Care, St. Antonius Hospital, Nieuwegein, The Netherlands.
¹⁰ Department of Intensive Care, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
¹¹ Department of Cardiology, Erasmus Medical Center, Erasmus University, Rotterdam, The Netherlands.
¹² Department of Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands.
¹³ Department of Intensive Care, Haga Hospital, The Hague, The Netherlands.
¹⁴ Department of Intensive Care, OLVG, Amsterdam, The Netherlands.
¹⁵ Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.
¹⁶ Department of Methodology & Statistics, Maastricht University, Maastricht, The Netherlands.
¹⁷ Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands.
¹⁸ Department of Cardiothoracic Surgery, Maastricht University Medical Center+, Maastricht University, Maastricht, The Netherlands.
¹⁹ School for Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands.

Abstract

Background: Prospective, trial-based data comparing health-related quality of life (HRQoL) in patients surviving out-of-hospital cardiac arrest (OHCA) through extracorporeal cardiopulmonary resuscitation (ECPR) or conventional CPR (CCPR) are scarce. We aimed to determine HRQoL during 1-year after refractory OHCA in patients treated with ECPR and CCPR.

Methods: We present a secondary analysis of the multicenter INCEPTION-trial, which studied the effectiveness of ECPR versus CCPR in patients with refractory OHCA. HRQoL was prospectively assessed using the EQ-5D-5L questionnaire. Poor HRQoL was pragmatically defined as an EQ-5D-5L health utility index (HUI) > 1 SD below the age-adjusted norm. We used mixed linear models to assess the difference in HRQoL over time and univariable analyses to assess factors potentially associated with poor HRQoL.

Results: A total of 134 patients were enrolled, and hospital survival was 20% (27 patients). EQ-5D-5L data were available for 25 patients (5 ECPR and 20 CCPR). One year after OHCA, the estimated mean HUI was 0.73 (0.05) in all patients, 0.84 (0.12) in ECPR survivors, and 0.71 (0.05) in CCPR survivors (p-value 0.31). Eight (32%) survivors had a poor HRQoL. HRQoL was good in 17 (68%) patients, with 100% in ECPR survivors versus 60% in CCPR survivors (p-value 0.14).

Conclusion: One year after refractory OHCA, 68% of the survivors had a good HRQoL. We found no statistically significant difference in HRQoL one year after OHCA in patients treated with ECPR compared to CCPR. However, numerical differences may be clinically relevant in favor of ECPR.

Keywords: Extracorporeal cardiopulmonary resuscitation; Health-related quality of life; Out-of-hospital cardiac arrest; Refractory arrest.