Functional Outcome and Independence Among In-Hospital Cardiac Arrest Patients in South India: A Prospective Longitudinal Study.

Introduction: The duration of cardiopulmonary resuscitation (CPR) has a strong effect on the prognosis and recovery of the patients. However, there is no standardization or Core Outcome Set for In-Hospital Cardiac Arrest. The main aim of the study is to assess the impact of CPR duration on functional outcome, survival, and the level of independence among cardiac arrest patients. Methods: For this observational study, 121 patients were selected from two tertiary hospitals in South India. Data were collected from patients during the event of cardiac arrest with functional outcome and level of independence measured immediate post-CPR, Day 30, and Day 90 using standardized tools, namely, cerebral performance category and Katz index tool for the level of independence. Results: The mean and median age was 62.49 ± 13.18 and 65 years (IQR, 54-73 years), respectively, with 89 (73.6%) male patients. At the end of CPR, 55.3% of patients achieved ROSC and with a mean and median CPR duration of 18.97 ± 14.7 min and 15 min (IQR, 10 and 26 min), respectively. Overall mortality rates were 33.8% immediately following CPR, 56.1% by Day 30, and 58.67% by Day 90, with an overall survival rate of 41.3% at 90 days. Immediately post-CPR, 95% of patients were in an unfavorable neurological state; this proportion improved to 37.19% by Day 30, with no significant further improvement observed by Day 90. Level of independence demonstrates that 83.7% of the patients were dependent during the immediate post-CPR period with improvement to partial independence among 84.9% of patients by Day 30. The mean score of favorable and unfavorable outcome on Day 90 was 1.02 and 4.93, respectively. The mean score of dependency and partially dependent on Day 90 among the survivor was 0 and 4.78, respectively. The predictors are ROSC, use of life-saving drugs, and CPR duration. Conclusion: Utstein reporting system must be integrated for cardiac arrest patients. Cardiac resuscitation and termination must be based on established policy and guidelines to maintain neurological integrity to sustain the quality of life during the post-CPR.