乌鸦传媒

MARBURG, Germany, July 17 -- Resuscitated cardiac arrest patients treated in an ICU who leave the hospital without severe neurological disabilities may expect a reasonable quality of life over the next five years, a study found.

Although the cost was about double that of average ICU patients, it compared favorably with other ICU interventions, such as mechanical ventilation or kidney dialysis, Jurgen Graf, M.D., of Philipps University Marburg, and colleagues reported in the July issue of Critical Care.

"We believe our study is the first to demonstrate that patients who leave the hospital following cardiac arrest without severe neurological disabilities may expect fair long-term survival and quality of life for reasonable expenses to the healthcare system," Dr. Graf's team concluded.

ICUs care for only a minority of patients, but they consume a large proportion of the hospital budget. Thus, Dr. Graf said, "restricting the demands for futile medical services by limiting access to the ICU, at least for patients likely to die anyway, has been proposed as a theoretical model to lower expenditures."

To investigate the costs and long-term health status after CPR for out-of-hospital or in-hospital cardiac arrest, the researchers investigated patients' health status five years after discharge from the University Hospital of Aachen in Germany and combined these outcomes with a full economic evaluation.

Of 354 patients admitted to the ICU from January 1999 through December 2001, 150 (42%) were discharged and 110 (31%) were alive in 2004, five years after hospital discharge. Eventually 81 five-year survivors answered the survey.

The researchers found the health-related quality of life at five years after hospital discharge was only slightly lower than age- and gender-matched apparently healthy German controls.

In addition, both the reported survival in the ICU and the hospital and health-related quality of life did not differ when compared with publications that were based on similar cardiac-arrest patients, other medical ICU patients, or ICU patients with sepsis.

After hospital discharge, only three patients (4%) relied on daily custodial care while six lived in nursing homes (5%).

Five years after hospital discharge, 13 (16%) were employed, 13 (16%) were early retired, and 48 (59%) were regularly retired because of age.

Except for pain, emotional function, and mental health, which varied, all other items on the health-related quality-of-life index were rated somewhat lower than in a matched population of apparently healthy Germans.

The 81 survivors reached a mean heath status index (HSI) of 0.77 (95% CI 0.70 to 0.85). Women rated their quality of life significantly better than men did (HSI 0.87 versus 90.74; P<0.05).

There were no differences in age, severity of illness, ICU and hospital lengths of stays, or admission diagnosis between men and women.

The individual items of pain, emotional function, and physical function were rated superior by women after five years (P<0.05).

In 2004, the total ICU costs for all 354 patients amounted to 6,312,700 € (about $8.1 million U.S.). In February 2004 the exchange rate was $1.285 so each Euro was worth $1.285 U.S.

This was approximately double the cost for an average ICU patient, but it compared favorably with other routine interventions, such as drug-eluting stents, mechanical intervention, and dialysis, in a variety of critically ill and non-ICU patients, the researchers said.

The cost of future healthcare for all 150 patients discharged alive was estimated to be 16,856,851 €, based on a projected remaining life span of 2,409 person years.

For the 110 patients known to be alive at five years, costs of future care were also considerably higher than for average ICU patients (68,116 € versus 14,130 €).

However, the costs per life year (approximately 9,930 €) and quality of life gained (about 13,000 €), are reasonable, the researchers said.

These outcomes compared favorably with general cardiovascular and pulmonary ICU patients from the same ICU, they said.

The results also compared favorably with other cost profiles for a variety of other interventions routinely done for the critically ill as well as non-ICU patients, they said.

The researchers listed several unique aspects or limitations of this study that need further consideration. First, healthcare costs do not usually end with hospital discharge, especially for critically ill patients.

Because estimates were based on costs provided by the German Bureau of Census, and because the majority of the patients in this cohort were readmitted at least once during the five-year follow-up, the true costs may be above the expected averages reported by the census bureau.

As for patients surviving hospital discharge with severe neurological deficits, "to the best of our knowledge," the researchers wrote, "we cannot judge the quality of life."

Also, both socioeconomic status and occupational class may affect patients' perception of quality of life, with lower status group reporting a quicker decline in self-reported health.

Despite some restrictions that emerged from methodologic -complexities inherent in any cost-outcome study conducted in an ICU, the costs per life-year and quality of life gained for these patients are reasonable, the researchers said.

Moreover, these data highlight the "somewhat skewed notion" that extreme expenses result from the care of patients who have undergone basic life support following cardiac arrest.

Although these patients may incur considerable costs and resource consumption, the trade-off between costs and outcome justifies such resource allocation, at least in comparison with other ICU patient groups.

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