Early follow-up and support for survivors and their families following out-of-hospital cardiac arrest: a factorial clinical feasibility trial

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Abstract Background: Following out-of-hospital cardiac arrest (OHCA), survivors may struggle to resume everyday life due to secondary consequences of surviving; cognitive impairments, mental fatigue and emotional challenges. Combined, these issues affect the family. Yet, evidence of targeted interventions to support OHCA survivors and their families is sparse. Purpose To evaluate the feasibility and acceptability of a complex intervention designed to support recovery after discharge for OHCA survivors and their families. Methods A multi-factorial one-arm feasibility study was conducted, following the Medical Research Council guidelines for complex interventions. The study included 20 OHCA survivors (≥18 year and a Cerebral Performance Category <2), and their closest relative. The intervention consisted of clinical consultations at 2, 4 and 8 weeks after discharge, telephone support as needed, and survivor cognitive screening at 8 weeks, with self-reported outcomes at baseline, 8 weeks and 6 months after discharge. Relatives were offered online or in-person peer-support groups, as preferred. Pre-defined progression criteria guided the feasibility evaluation included: Recruitment: A recruitment rate of ≥70% for survivors and ≥80% for relatives. Data-collection: A response rate of >80% for both survivor and relatives at baseline and follow-up. Retention: A drop-out rate <20%. Adherence: Adherence rates of >80% of all consultations for survivors and relatives, and >50% for relatives attending peer-support groups. Capacity of providers: Adherence to the planned consultation time-frame, with >80% of the consultations staying within estimated time (30 minutes per consultation). Acceptability: Measured using the Theoretical Framework of Acceptability questionnaire with >90% rating the intervention as 4 or 5 on a Likert scale (1=low acceptability). Results The following progression criteria was achieved: recruitment (91% for survivors, 100% for relatives), retention (no/0% drop-out), acceptability (survivors 80%, relatives 100%), and adherence to follow-up for survivors (≥90%). Data collection rates at baseline (survivors 95%, relatives 94%) and follow-up (survivors 80%, relatives 83%) also met the criteria. Participation in peer-support groups for relatives (17%) and adherence to follow-up for relatives (78%) did not demonstrate intervention feasibility based on the progression criteria. Capacity of providers criteria was not met, with consultation times exceeding 30 minutes in 16%, 25% and 47% of the consultations at the three consultations, respectively. Conclusion This study demonstrated the targeted support intervention for OHCA survivors and their families was highly feasible, meeting the majority of pre-defined progression criteria. However, the peer-support component of the intervention, follow-up structure for relatives, consultation timeframe needs refinement. The findings will inform the development of an intervention for a large-scale clinical trial.

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