Physical impairment as the dominant component of new-onset post-intensive care syndrome following in-hospital resuscitation

Tak Kyu Oh; In-Ae Song

doi:10.1016/j.resuscitation.2026.111085

Physical impairment as the dominant component of new-onset post-intensive care syndrome following in-hospital resuscitation

Resuscitation. 2026 Jun:223:111085. doi: 10.1016/j.resuscitation.2026.111085. Epub 2026 Apr 10.

Authors

Tak Kyu Oh¹, In-Ae Song²

Affiliations

¹ Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
² Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea; Department of Anesthesiology and Pain Medicine, College of Medicine, Seoul National University, Seoul, South Korea. Electronic address: songoficu@outlook.kr.

PMID: 41967758
DOI: 10.1016/j.resuscitation.2026.111085

Abstract

Aim: Addressing sparse nationwide data, this study evaluated the 12-month cumulative incidence and clinical predictors of new-onset post-intensive care syndrome (PICS) and its specific domains among in-hospital cardiac arrest (IHCA) survivors.

Methods: This nationwide population-based cohort study utilized the South Korean National Health Insurance Service database (2013-2023). New-onset PICS was identified through International Classification of Diseases, 10th Revision (ICD-10) coded diagnoses within administrative claims data, representing healthcare utilization-based incidence rather than true symptomatic prevalence.

Results: Within the final analytic cohort of 43,331 hospital survivors, the 12-month cumulative incidence of new-onset PICS was 6.7% (95% confidence interval [CI], 6.5-6.9%). These findings reflect healthcare utilization-based incidence, capturing only those impairments that led to formal medical encounters and ICD-10 coding. In a sensitivity analysis of stable one-year survivors (n = 11,862), the incidence significantly rose to 15.9% (95% CI, 15.3-16.6%). Physical impairment was the dominant domain (15.0%), while cognitive (0.5%) and psychiatric (0.8%) domains showed lower rates, suggesting a potential "masking effect" or "floor effect" due to severe neurological injury. Extracorporeal membrane oxygenation support (odds ratio [OR] 1.44, P < 0.001), and increased length of hospitalization were robust predictors. Notably, the odds of PICS diagnosis significantly escalated from 2021 onwards, peaking in 2022 (OR 2.19) and 2023 (OR 2.12).

Conclusions: New-onset PICS, driven by physical decline, affects one in six IHCA survivors surviving the first year. Acute care intensity and recent trends highlight the need for early screening and intensive rehabilitation for high-risk survivors.

Keywords: Activities of daily living; Cardiopulmonary resuscitation; Critical illness; Heart arrest; Survivors.

MeSH terms

Aged
Cardiopulmonary Resuscitation* / adverse effects
Critical Illness
Female
Heart Arrest* / mortality
Heart Arrest* / therapy
Humans
Incidence
Male
Middle Aged
Republic of Korea / epidemiology
Risk Factors
Survivors / statistics & numerical data

Supplementary concepts

postintensive care syndrome