Improving Neurological, Functional, and Participatory Survival After Cardiac Arrest
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See Article by Lilja et al
To improve outcomes, it is essential to measure outcomes. A study in this issue of Circulation: Cardiovascular Quality and Outcomes highlights the need to improve the rigor and texture by which we measure outcomes after cardiac arrest.1 Historically, clinical research on cardiac arrest characterized the quality of survival using an ordinal scale of performance, the Cerebral Performance Category (CPC). CPC was developed originally as an ad hoc measure for an early clinical trial, based on the then-current version of the Glasgow Outcome Score, a common instrument for trauma research.2 CPC has many descriptions, but it has no single instrument, has moderate inter-rater reliability, and has not proven reliable when estimated in different manners (eg, in-person examination versus over the telephone interview versus chart review). Many papers incorrectly describe CPC as a measure of neurological outcome, but the levels of the CPC contain descriptions of functional capacity and participation in activities and neurological impairment.3 It is, thus, a mixed measure of multiple domains of patient health.
Lilja et al1 studied a cohort of patients who survived cardiac arrest in the large TTM (Targeted Temperature Management) clinical trial that compared 2 temperature management regimens. The TTM trial detected no differences in primary outcomes between temperature management strategies, making it possible to examine long-term survival in all survivors. Using detailed and rigorous neuropsychological, functional, and social assessments at 180 days after the cardiac arrest in 287 subjects, this study revealed that one half of survivors experience reduced participation in employment or other premorbid activities.