Cardiac Arrest Survivorship Research Hub

Sudden cardiac arrest (SCA) remains a major global health concern, with an estimated 300,000 to 400,000 deaths annually in the United States and around two million worldwide. In 2020, the American Heart Association (AHA) updated the Chain of Survival by adding a new component recovery to highlight the importance of post-resuscitation care. However, the implementation of this recovery phase remains limited and requires further exploration. This study aimed to review the implementation of the recovery phase within the Chain of Survival. A scoping review design was employed, with literature searches conducted in ScienceDirect, ProQuest, Sage, and PubMed databases using the keywords (“Cardiac Arrest”) AND (“Chain of Survival”) AND (“Recovery”) AND (“Rehabilitation”). The inclusion criteria included articles published within the last five years, written in English, and available in full-text open access format. Of the 330 articles initially identified, 13 met the eligibility criteria and were analysed using the Joanna Briggs Institute framework, with the findings reported in accordance with the PRISMA-ScR guidelines. Three major themes emerged: (i) multidimensional challenges among survivors, including physical, cognitive, psychological, and social impairments; (ii) multidisciplinary interventions, such as the ROCK and SCARF programmes, which were shown to improve quality of life, reduce fatigue, and enhance independence; and (iii) factors influencing recovery, including biomarkers, prognostic scores, and socioeconomic status. The recovery phase is a crucial yet often neglected component of the Chain of Survival. Post-cardiac arrest care should adopt a comprehensive and integrated approach involving evidence-based rehabilitation, psychological support, and family counselling to achieve optimal recovery and long-term quality of life.

IMPORTANCE: Guidelines for temperature control following out-of-hospital cardiac arrest (OHCA) are based on trials with end points of 180 days or fewer. OBJECTIVES: To investigate if targeted hypothermia, compared with targeted normothermia with early treatment of fever, affects functional outcome focusing on societal participation or cognitive functioning at 24 months in initially comatose OHCA survivors. An additional objective was to explore recovery trajectories up to 24 months post arrest. DESIGN, SETTING, AND PARTICIPANTS: The randomized clinical Targeted Hypothermia vs Targeted Normothermia After OHCA (TTM2) trial (November 2017-2020) included blinded follow-up at 1, 6, and 24 months post randomization (December 2017-June 2022), with analyses performed in 2024. TTM2 was an international, multicenter study conducted at 61 hospitals in 14 countries. The study included 1861 adults with OHCA of presumed cardiac or unknown cause who were initially comatose. There were 992 survivors at 1 month, 943 at 6 months, and 835 at 24 months. Nonparticipation rates at follow-up were 44 (4%), 107 (11%), and 165 (20%), respectively. INTERVENTION: Participants were randomized 1:1 to undergo temperature control via targeted hypothermia (33 °C) or targeted normothermia and early treatment of fever (≥37.8 °C). MAIN OUTCOMES AND MEASURES: The functional outcome, including societal participation, was assessed using the Glasgow Outcome Scale-Extended (GOSE). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and the Symbol Digit Modalities Test (SDMT). RESULTS: Of the participants who were followed up, 84% were male, with a mean (SD) age of 60 (14) years, and clinical variables were similar between the hypothermia and normothermia temperature groups. No significant differences were found between temperature groups regarding societal participation (GOSE: odds ratio, 0.97 [95% CI, 0.72-1.30]) or cognitive function (MoCA: mean difference, -0.02 [95% CI, -0.67 to 0.63]; SDMT: mean difference, -0.09 [95% CI, -0.33 to 0.16]) at 24 months. Improvement for GOSE was significant within the first 6 months (1 to 6 months: n = 1707 [95% CI, -2.00 to -1.50]; P < .001; 6 to 24 months: n = 1606 [95% CI, -0.50 to <0.001]; P = .10). Intraindividual improvement and decline corresponding to thresholds for minimal important differences were observed for societal participation and cognitive function up to 24 months. CONCLUSIONS AND RELEVANCE: Targeted hypothermia, compared with targeted normothermia, did not affect societal participation or cognitive function at 24 months, suggesting no longer-term effect of hypothermia for the explored outcomes. The intraindividual changes observed indicate variability in recovery. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02908308.

INTRODUCTION: The primary goal of this scoping review was to create a comprehensive synthesis of the characteristics, management, and outcomes of perioperative CA events in children undergoing noncardiac surgery. METHODS: We conducted electronic searches of PubMed, Embase, and Scopus in February 2024, with an update in June 2025. Inclusion and exclusion criteria were defined a priori. We included studies in children (age <18 years) undergoing noncardiac surgery, experiencing CA while under the care of anesthesia personnel or in immediate postoperative phases, with at least one pre-defined survival, neurofunctional, quality of life, or healthcare utilization outcome ascertained. Two authors reviewed citations independently with a third author solving conflicts. RESULTS: Of 801 unique citations, 18 studies met inclusion criteria. There were 17 retrospective cohort studies, 1 cross sectional study, and no interventional studies. Median number of CA events per study was 21 (interquartile range, 13-27). Survival to hospital discharge ranged from 30% to 91% overall, with survival of 46% in the U.S.-based study. Younger age, higher American Society of Anesthesiologists score, and emergent procedures were associated with higher CA event occurrence. No study reported data on CA management, including quality of resuscitation, medication use, or defibrillation use. No studies obtained neurofunctional outcomes using standardized measures. No studies addressed long-term survival, neurofunctional, healthcare utilization, or quality of life outcomes after hospital discharge. CONCLUSION: Studies on pediatric perioperative CA are heterogenous, with modest sample sizes, and variability in definitions and reporting of outcomes. A large knowledge gap remains in CA management, neurologic consequences, and long-term outcomes.