Long-term survival and neurological outcome of patients who received recombinant tissue plasminogen activator during out-of-hospital cardiac arrest

Objective: The long-term outcome in patients who received recombinant tissue plasminogen activator during cardiopulmonary resuscitation (CPR) in out-of-hospital cardiac arrest (OHCA) of non-traumatic aetiology was assessed. Methods: The neurological outcome in survivors and their level of performance, subjective well-being and quality of life were evaluated. Results: A follow-up study of 27 cardiac arrest survivors was conducted; four patients (15%) died during the first year, a total of seven patients (26%) within 5 years. Twenty-two patients (81%) were discharged from hospital without neurological deficit (cerebral performance category (CPC) score: 1), three patients scored CPC 2 and two patients CPC 3. Heart failure classification on discharge was, according to the New York Heart Association (NYHA) criteria 2.1±0.9. Fifteen patients (56%) managed to return to their previous level of activity. At the time of follow-up 18 patients (67%) were still alive, of whom 15 responded to a survey regarding life satisfaction. Thirteen patients (87%) judged their situation to be worth living and twelve (80%) considered their survival a second chance, while five (33%) feared they could suffer another cardiac arrest. Reactions from close relatives included fear/anxiety ( n=14; 78%), a sustained burden on family life ( n=12; 67%), and occasional depression ( n=7; 39%). Conclusions: Thrombolytic therapy during cardiopulmonary resuscitation may produce a favourable neurological outcome. The majority of long-term survivors reported a good subjective quality of life. In one-third of close family members some negative factors had a lasting impact on the quality of daily living. Objectivo: Avaliar o prognóstico a longo prazo de doentes que receberam activador do plasminogénio tecidular recombinante durante a Reanimação Cardio-Pulmonar (CPR), na paragem cardı́aca extra-hospitar (OHCA) de etiologia não traumática. Métodos: Foi avaliado o resultado neurológico dos sobreviventes, o nı́vel de desempenho, o bem-estar subjectivo e a qualidade de vida. Resultados: Foram estudados e seguidos 27 sobreviventes de paragem cardı́aca; quatro doentes (15%) morreram durante o primeiro ano e um total de sete pacientes (26%) durante 5 anos. Vinte e dois doentes (81%) tiveram alta hospitalar sem défices neurológicos (Categoria de Desempenho Profissional (CPC): 1), três doentes com score CPC2 e dois doentes CPC3. A classificação da Insuficiência Cardı́aca à alta foi realizada de acordo com os cr