Cognitive Function, Quality of Life and Mental Health in Survivors of Out-of-Hospital Cardiac Arrest: A Review

Abstract

There is growing interest in the long-term outcomes of patients surviving out-of-hospital cardiac arrest (OHCA). This paper aims to summarise the available literature on the long-term cognitive, health-related quality of life (QoL) and mental health outcomes of survivors of OHCA. Between 30 and 50% of survivors of OHCA experience cognitive deficits for up to several years post-discharge. Deficits of attention, declarative memory, executive function, visuospatial abilities and verbal fluency are commonly reported. Survivors of OHCA appear to report high rates of mental illness, with up to 61% experiencing anxiety, 45% experiencing depression and 27% experiencing post-traumatic stress. Fatigue appears to be a commonly reported longterm outcome for survivors of OHCA. Investigations of long-term QoL for these patients have produced mixed findings. Carers of survivors of OHCA report high rates of depression, anxiety and post-traumatic stress, with insufficient social and financial support. The heterogeneous range of instruments used to assess cognitive function and QoL prevent any clear conclusions being drawn from the available literature. The potential biases inherent in this patient population and the interaction between QoL, cognitive performance and mental health warrant further investigation, as does the role of post-discharge support services in improving long-term patient outcomes.

Neuropsychological Outcomes of Children 1 Year After Pediatric Cardiac Arrest

“…Similarly, for adults after out-of-hospital CA, memory is the domain most significantly affected, although executive functioning, fine motor, and visuospatial skills are also adversely affected. [6][7][8][9][10][11] We found the greatest impairment based on measures of visual memory, with relatively less impairment based on verbal memory measures; this pattern (greater visual relative to verbal memory impairment) has previously been reported for survivors of pediatric CA. 22 In this population, individualized neuropsychological assessment can guide appropriate cognitive rehabilitation and educational services, especially for older children.…”

“…For adult out-of-hospital CA survivors, memory is most impaired, and deficits in executive functioning, fine motor skills, and visuospatial skills are often present. [6][7][8][9][10][11] Because these specific domains of neuropsychological functioning are not as well developed or readily testable in young children, we describe neuropsychological outcomes separately for younger and older children. The goal of the present study is to provide novel information about the spectrum of neuropsychological outcomes of children after CA by age group and more precisely delineate neuropsychological functioning of children in both age groups classified as having favorable outcomes.…”

Cognitive and Functional Consequence of Cardiac Arrest

“…These results are similar to those reported in smaller studies from Sweden, Canada, and the Netherlands, and it is reasonable to conclude that the majority of survivors after OHCA are independent, able to return to work and maintain a good QoL [62][63][64][65]. Another important factor that may lead to impaired QoL and functional outcome is fatigue, which has been reported in a high proportion of survivors of OHCA [66].…”

“…However, the study was not powered to assess cognitive outcomes and results need to be interpreted with caution [13]. Nonetheless, this study reinforces the fact that severe neurological impairment is rare among survivors of cardiac arrest, but cognitive dysfunction may be underestimated given limitations in study design including standardized neuropsychological testing [55,66].…”

Goals of Therapy: Should We Ask what Our Patients Really Want?

“…While the patients' respiratory symptoms had largely improved, they still suffered from significant weakness and fatigue, with persistent limitations in their functional state at five years 7 . In this issue, Green et al present a review of functional outcomes for survivors of those who suffered an out-of-hospital cardiac arrest 8 . They showed that almost half of all survivors had cognitive impairment and mental health issues.…”