Prevalence of Near-Death Experiences (NDE) in Patients with Refractory Cardiac Arrest Treated with Conventional and Extracorporeal Cardiopulmonary Resuscitation

Abstract

Objective: Near-death experiences (NDE) have not yet been studied in patients with refractory cardiac arrest treated with extracorporeal cardiopulmonary resuscitation (ECPR). The aim of this pilot project was to determine the prevalence of NDEs in patients from the randomized Prague OHCA study with refractory cardiac arrest and to analyze differences between patients resuscitated with standard cardiopulmonary resuscitation (CPR) and those resuscitated using the ECPR method. Methods: NDEs were analyzed using a standardized and internationally validated questionnaire among long-term survivors of the randomized Prague OHCA study. The prevalence of NDEs was compared between patients treated with standard CPR and those resuscitated with the ECPR method. Results: The questionnaire was completed by 44 out of 60 patients who were followed up long-term after the Prague OHCA study (median age: 57.5 years, 83% male, average CPR duration: 37.5 minutes), including 12 patients treated with ECPR (average cardiac arrest duration: 54 minutes). At least one symptom of NDE was experienced by 15/44 patients (34.1%), including 10/32 (31.3%) in the standard CPR group and 5/12 (41.6%) in the ECPR group (p = 0.52). Criteria for a complete NDE (score ≥28 on the NDE questionnaire) were met by 9/44 patients (20.5%), including 6/32 (18.8%) in the standard CPR group and 3/12 (25%) in the ECPR group (p = 0.65). Conclusion: The prevalence of NDEs in our cohort of patients with refractory cardiac arrest corresponds to the prevalence reported in previous studies that analyzed patients treated with standard CPR and shorter durations of cardiac arrest. The numerically higher occurrence of NDEs in patients treated with the ECPR strategy is hypothesis-generating but did not reach statistical significance. Further conclusions require analysis in larger patient cohorts.