Chronic memory impairment after cardiac arrest outside hospital

Grubb, Neil R.; O’Carroll, Ronan E.; Cobbe, Stuart M.; Sirel, J M; Fox, Keith A.A.

doi:10.1136/bmj.313.7050.143

Cited by 102 publications

(101 citation statements)

References 26 publications

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“…A recent study examining cognitive performance and specifically executive function in a population of general intensive care survivors found these functions to be very significantly impaired at least three months after discharge from ICU. 24 Grubb et al reported a correlation between resuscitation delays and memory impairment, 4 but the prospective study of Roine et al 2 did not find a similar correlation, and the prospective study of van Alem et al 3 reported only a weak correlation. It thus seems that long delays in the resuscitation do not exclude the possibility of good cognitive outcome.…”

Section: Discussionmentioning

confidence: 71%

“…One study with 35 subjects focusing on memory deficits found moderate to severe memory impairment in 37% of survivors at 7 months after CA. 4 Quantitative electroencephalography (Q-EEG) and P300 event-related potential have been studied in various disorders of brain function with cognitive impairment, especially in dementing illnesses and mild cognitive decline. 5 Q-EEG uses computer software to provide topographic analysis of brain activity.…”

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confidence: 99%

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Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Tiainen

Poutiainen

Kovala

et al. 2007

Stroke

105

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Background and Purpose-Cognitive deficits are common in survivors of cardiac arrest (CA). The aim of this study was to examine the effect of therapeutic hypothermia after CA on cognitive functioning and neurophysiological outcome. Methods-A cohort of 70 consecutive adult patients resuscitated from out-of-hospital ventricular fibrillation CA were randomly assigned to therapeutic hypothermia of 33°C for 24 hours accomplished by external cooling or normothermia.Neuropsychological examination was performed to 45 of the 47 conscious survivors of CA (27 in hypothermia and 18 in normothermia group) 3 months after the incident. Quantitative electroencephalography (Q-EEG) and auditory P300 event-related potentials were studied on 42 patients at the same time point. Results-There were no differences between the 2 treatment groups in demographic variables, depression, or delays related to the resuscitation. No differences were found in any of the cognitive functions between the 2 groups. 67% of patients in hypothermia and 44% patients in normothermia group were cognitively intact or had only very mild impairment.Severe cognitive deficits were found in 15% and 28% of patients, respectively. All Q-EEG parameters were better in the hypothermia-treated group, but the differences did not reach statistical significance. The amplitude of P300 potential was significantly higher in hypothermia-reated group. Conclusions-The use of therapeutic hypothermia was not associated with cognitive decline or neurophysiological deficits after out-of-hospital CA.

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Section: Discussionmentioning

confidence: 71%

mentioning

confidence: 99%

Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Tiainen

Poutiainen

Kovala

et al. 2007

Stroke

105

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“…Previous studies of cardiac arrest quality of life were relatively small and did not attempt to identify the predictors of very good quality of life. [11][12][13] These other studies used a variety of instruments, including the Sickness Impact Profile, the Medical Outcome Short Form 36, and the Functional Status Index. 27 Our study is the first to use the HUI3 for an exclusively out-of-hospital cardiac arrest population.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Several investigators have recently evaluated the outcomes or quality of life of survivors of out-of-hospital cardiac arrest. [11][12][13][14] We have previously found that most patients who survive to hospital discharge have quite good quality of life and functional status. 15 Little is known, however, about the factors that may correlate with or lead to better functional status for these cardiac arrest survivors.…”

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confidence: 99%

Health-Related Quality of Life Is Better for Cardiac Arrest Survivors Who Received Citizen Cardiopulmonary Resuscitation

et al. 2003

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Background-This study evaluated the prehospital factors associated with better health-related quality of life for survivors of out-of-hospital cardiac arrest. Methods and Results-This prospective, 20-community, cohort study involved consecutive, adult out-of-hospital cardiac arrest patients who survived to 1 year. Patients were contacted by telephone and evaluated for the Health Utilities Index Mark III (HUI3), which describes health as a utility score on a scale from 0 (dead) to 1.0 (perfect health). The 8091 cardiac arrest patients had overall survival rates of 5.2% to hospital discharge and 4.0% to 1 year. We successfully contacted and evaluated 268 of 316 (84.8%) of known 1-year survivors. The median HUI3 score was 0.80 (interquartile range, 0.50 to 0.97), which compares well with age-adjusted values for the general population (0.83). Logistic regression identified 2 factors independently associated with very good quality of life (HUI3 Ͼ0.90) and their odds ratios (95% CIs), as follows: age 80 years or older, 0.3 (0.1 to 0.84), and citizen-initiated cardiopulmonary resuscitation (CPR), 2.0 (1.2 to 3.4) (Hosmer-Lemeshow goodness-of-fit statistic, 0.74). Conclusions-This study is the largest ever conducted for out-of-hospital cardiac arrest survivors, clearly shows that these patients have good quality of life, and is the first to demonstrate that citizen-initiated CPR is strongly and independently associated with better quality of life. These results emphasize the importance of optimizing community citizen CPR readiness. Given the low rate of citizen-initiated CPR in many communities, we believe that local and national initiatives should vigorously promote the practice of bystander CPR.

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“…9,10 In a recent review, 30% to 50% of survivors after cardiac arrest were reported to suffer from cognitive impairment. 11 The generalizability of previous studies is poor because of small sample sizes, [12][13][14] missing data, 13,14 and patient selection, that is, the exclusion of those with a poor outcome, 14 inclusion of only patients with severe symptoms, 12 or absence of a nonarrest control group. 11 Optimally, OHCA survivors should be evaluated for the cognitive functions known to be most affected: memory, attention, and executive functions.…”

Section: Clinical Perspective On P 1349mentioning

confidence: 99%

Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33°C Versus 36°C

et al. 2015

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Background— Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim of this study was to evaluate whether a target temperature of 33°C compared with 36°C was favorable for cognitive function; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general. Methods and Results— Study sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33°C or 36°C within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33°C, n=178/328; 36°C, n=164/324). Survivors were invited to a face-to-face follow-up, and 287 cardiac arrest survivors (33°C, n=148/36°C, n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery), and attention/mental speed (Symbol Digit Modalities Test). A control group of 119 matched patients hospitalized for acute ST-segment–elevation myocardial infarction without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ ( P >0.30) between the 2 temperature groups (33°C/36°C). Compared with control subjects with ST-segment–elevation myocardial infarction, attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar. Conclusions— Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment–elevation myocardial infarction not having had a cardiac arrest. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT01946932.

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Chronic memory impairment after cardiac arrest outside hospital

Cited by 102 publications

References 26 publications

Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Health-Related Quality of Life Is Better for Cardiac Arrest Survivors Who Received Citizen Cardiopulmonary Resuscitation

Cognitive Function in Survivors of Out-of-Hospital Cardiac Arrest After Target Temperature Management at 33°C Versus 36°C

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