P3431Care after resuscitation - an early psychological support service for out of hospital cardiac arrest survivors

Abstract

Introduction: Every year 30,000 patients in the UK suffer an out of hospital cardiac arrest (OHCA). Improvements in first aid training and timely medical intervention have led to increased survival rates. In a previous study, we highlighted inadequacies in psychosocial support services for survivors. Issues included depression, anxiety, impaired cognitive function, on-going medical complaints and reduced quality of life. A randomised control trial in cardiac arrest survivors, found that those offered early intervention and support had significantly better emotional, mental and general health at 1 year compared to controls. Purpose: Having identified an inadequacy in care and support for this group of patients, we aimed to provide the first dedicated follow-up service provided by an NHS trust for OHCA survivors. Methods: 21 consecutive patients who survived to discharge (CPC1-2) from the Essex Cardiothoracic Centre following an OHCA were offered early psychological follow-up which consisted of: 1) Review pre-discharge by a senior ICU nurse and cardiologist. Psychological assessment was performed. 2) All patients received a written information leaflet, about what to expect from life post cardiac arrest. 3) Patients were encouraged to watch a bespoke video 4) At 48 hours post discharge, patients were contacted via telephone at home. 5) At 2 months, a formal Care After REsuscitation (CARE) outpatient appointment was arranged and attended by a senior ICU nurse and a cardiologist. Appointments were 1 hour, and the interview focused upon psychological effects following the OHCA. Cognitive function, quality of life and emotional well being are assessed by a quality of life questionnaire (SF-36). Medical concerns are addressed by the attending cardiologist. A further follow-up was arranged at 6 months. Where appropriate patients were referred to counselling services, neuropsychologist and psychiatrist. Results: Of the 21 patients recruited, 2 died prior to follow-up. The average age in our group was 61 with 84% being male. All patients were discharged directly home from hospital. We achieved 100% follow-up. Compared to baseline, there were significant improvements in quality of life scores at 6 months using the SF- 36 questionnaire. Physical and social functioning, emotional and mental health as well as vitality and bodily pain significantly improved (p<0.005). 5 patients (26%) required referral to a psychiatrist. Conclusion: We have demonstrated a clear clinical need for specific follow-up arrangements in OHCA survivors. Our service is the first in the UK, and has been established quickly and efficiently with local funding. We have shown significant improvement at 6 months compared to baseline. Our future aim is to expand the service to cater for more patients locally and provide a framework for other NHS trusts to follow in offering such a service for OHCA survivors nationally.