Abstract Body: Background: Cardiac arrest survivorship is wrought with psychological, physical, and cognitive disability, much of which goes underrecognized by healthcare professionals. Discharge planning is not standardized, thus limiting access to critical evaluations and services that have the potential to impact intermediate and long-term outcomes.
Aims: We describe the development of a novel cardiac arrest recovery clinic.
Methods: At our institution, all unresponsive cardiac arrest survivors are followed prospectively by our neurocritical care consult service who provide recommendations on brain centered resuscitation and neuroprognostication. Eligibility for CARP included patients admitted to an intensive care unit following out-of-hospital (OHCA) or in-hospital cardiac arrest (IHCA) who subsequently regained consciousness and were following commands prior to discharge. Nurse navigators (JG, KN) and neurointensivists (RB, EG) tracked inpatient recovery and coordinated with the primary medical team and rehab colleagues to ensure optimal discharge planning. The primary outcome was incidence of cognitive deficits at hospital discharge. Secondary outcomes included discharge disposition.
Results: Between February 1 and June 4, 2024, 54 patients, including 24 IHCA and 30 OHCA, were screened for eligibility, of which 22 (41%) were enrolled in the CARP program. Patients with IHCA were more likely to be enrolled than patients with OHCA [13 (54%) vs. 9 (30%)]. Prior to discharge, all eligible patients underwent cognitive screening performed by speech and language pathology, which identified 18 (82%) with cognitive deficits. All CARP enrollees were referred to neurology resident clinic; of those with cognitive impairment, 16 (89%) were also referred to neuropsychology. Discharge disposition included 8 (40%) to home ± services, 7 (35%) to acute rehab, 4 (20%) to short term rehab, and 1 (5%) to inpatient substance abuse recovery program. Follow up data is pending.
Conclusions: Amongst cardiac arrest survivors, in-hospital cognitive screening by speech and language pathology was feasible and frequently identified cognitive impairment not detected on crude bedside assessments. Using a prospective screening approach, we were able to track inpatient recovery, anticipate discharge needs, and facilitate expedited outpatient neuropsychological evaluations. CARP will continue to perform a needs assessment regarding resources with the potential to improve survivorship.