Postresuscitation psychiatric disorders and epilepsy in traumatic and nontraumatic out-of-hospital cardiac arrest survivors: a retrospective real-world study.

Abstract

BACKGROUND AND IMPORTANCE: Survivors of out-of-hospital cardiac arrest (OHCA) often develop psychiatric and epilepsy problems. When arrest occurs with trauma, hypoxic-ischemic, and injury-related insults may heighten risks vs. nontraumatic OHCA. OBJECTIVES: To estimate 5-year risks of psychiatric disorders and epilepsy after traumatic vs. nontraumatic OHCA, and to examine whether early pharmacologic treatment relates to outcomes. DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective cohort using deidentified records from the TriNetX U.S. Collaborative Network (January 2010-June 2023). Adults with return of spontaneous circulation surviving >30 days were categorized as traumatic ( n  = 1477) or nontraumatic ( n  = 5165). Groups were balanced by 1:1 propensity score matching (caliper 0.1). INTERVENTION OR EXPOSURE: Exposure involved traumatic as opposed to nontraumatic OHCA. OUTCOME MEASURES AND ANALYSIS: Primary outcomes were overall psychiatric disorders, including categories of schizophrenia, mood disorders, depressive disorder, other nonpsychotic mental disorders, anxiety disorders (including phobic and other types), and posttraumatic stress disorder (PTSD). The secondary outcome was epilepsy. Kaplan-Meier and Cox models were used to calculate 5-year cumulative incidence and hazard ratios (HRs) with 95% confidence intervals (CIs). MAIN RESULTS: The primary outcomes showed that survivors of traumatic OHCA faced greater 5-year risks of overall psychiatric disorders (HR, 1.38; 95% CI, 1.13-1.7), including multiple categories. HRs of categories were: schizophrenia, 2.23 (95% CI, 1.06-4.68); mood disorders, 1.38 (1.07-1.78); depressive episodes, 1.57 (1.19-2.08); other nonpsychotic mental disorders, 1.51 (1.20-1.92), including phobic anxiety disorders, 1.46 (0.72-2.93) and other anxiety disorders, 1.51 (1.17-1.95); and PTSD, 1.60 (1.02-2.50). The risk of secondary outcome epilepsy increased progressively over time, reaching the highest level at 5 years post-OHCA (HR, 2.06; 95% CI, 1.30-3.26). CONCLUSION: Traumatic OHCA survivors had higher long-term risks of psychiatric disorders and epilepsy. Early targeted interventions and structured follow-up may help mitigate these risks, warranting confirmation in future prospective studies.