Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest

Abstract

Objective: We aimed to study the long-term cognitive abilities of patients surviving out-of-hospital cardiac arrest who were treated with therapeutic hypothermia (TH). Methods:We prospectively identified and examined consecutive survivors of out-of-hospital cardiac arrest who underwent TH at our institution from June 2006 to May 2011. The results of brain imaging, serum neuron-specific enolase (NSE) measurements, and EEGs were recorded. We assessed cognitive domains using the modified Telephone Interview for Cognitive Status. An education-adjusted score of $32 was considered normal.Results: Of 133 total patients, 77 (58%) were alive at a median follow-up of 20 months (interquartile range 14-24 months). We interviewed 56 patients (73% of those alive). Median age was 67 years (range 24-88 years). Fifty-one patients (91%) were living independently. Modified Telephone Interview for Cognitive Status scores ranged from 16 to 41. Thirty-three (60%) were considered cognitively normal and 22 (40%) were cognitively impaired. The time to assessment did not differ among the cognitive outcomes (p 5 0.557). The median duration of coma was 2 days, possibly indicating that patients with severe anoxic injury were not included. Eighteen patients were not working at the time of their cardiac arrest (17 were retired and 1 was unemployed). Of the 38 patients who were working up to the time of the cardiac arrest, 30 (79%) returned to work. Cognitive outcome was not associated with age, time to return of spontaneous circulation, brain atrophy, or leukoaraiosis. Conclusions:The majority of surviving patients who underwent TH after cardiac arrest in this series had preserved cognitive function and were able to return to work.

Cognitive function and health-related quality of life four years after cardiac arrest

“…10,22 The pattern of impairment indicates dysfunction in medial temporal lobe structures, as seen, for instance, in early Alzheimer's dementia. 23 We found memory impairments in the Paired Associates Learning (PAL) and a marked decrease in correct answers at 12 s delay, compared to 0 s delay, in the Delayed Matching to Sample (DMS).…”

Pharmacologically induced hypothermia attenuates traumatic brain injury in neonatal rats

“…Hypothermia was also shown to protect cardiac arrest survivors against cognitive disability (Fugate, et al, 2013). In animal studies, rats under hypothermia combined with erythropoietin (EPO) treatment against hypoxia-ischemia showed an improved sensorimotor function detected by cylinder-rearing test (Fan, et al, 2013).…”

European Heart Rhythm Association (EHRA)/Heart Rhythm Society (HRS)/Asia Pacific Heart Rhythm Society (APHRS)/Latin American Heart Rhythm Society (LAHRS) expert consensus on arrhythmias and cognitive function: What is the best practice?

“…At the present time, compelling evidence supports the use of targeted therapeutic hypothermia. Effectiveness of therapeutic hypothermia to prevent cognitive impairment has been reported with varying results among different authors . For example, Fugate et al followed 56 survivors of cardiac arrest treated with therapeutic hypothermia.…”