Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment

Pußwald, Gisela; Fertl, Elisabeth; Faltl, Margit; Auff, Eduard

doi:10.1016/s0300-9572(00)00240-9

Cited by 139 publications

(103 citation statements)

References 21 publications

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confidence: 99%

“…Mortality rates with cardiac arrest range from 60% to 85%, and approximately 80% of survivors are initially comatose (1)(2)(3). Of those who survive, 50% are left with a permanent neurologic disability, and only 10% are able to resume their former lifestyle (1,2). Multiple methods have been assessed for prognostic value in this setting, including the clinical examination (3), electrophysiology with electroencephalography (4) and somatosensory evoked potentials (5), and plasma biomarkers indicative of neuronal cell death (6).…”

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confidence: 99%

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Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Sorensen²,

Benner³

et al. 2009

Radiology

169

112

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Purpose:To examine whether the severity and spatial distribution of reductions in apparent diffusion coefficient (ADC) are associated with clinical outcomes in patients who become comatose after cardiac arrest. Materials and Methods:This was an institutional review board-approved, HIPAAcompliant retrospective study of 80 comatose patients with cardiac arrest who underwent diffusion-weighted magnetic resonance imaging. The need to obtain informed consent was waived except when follow-up phone calls were required; in those cases, informed consent was obtained from the families. Mean patient age was 57 years Ϯ 16 (standard deviation); 31 (39%) patients were women. ADC maps were semiautomatically segmented into the following regions: subcortical white matter; cerebellum; insula; frontal, occipital, parietal, and temporal lobes; caudate nucleus; putamen; and thalamus. Median ADCs were measured in these regions and in the whole brain and were compared (with a two-tailed Wilcoxon test) as a function of clinical outcome. Outcome was defined by both early eye opening in the 1st week after arrest (either spontaneously or in response to external stimuli) and 6-month modified Rankin scale score. Results:Whole-brain median ADC was a significant predictor of poor outcome as measured by no eye opening (specificity, 100% [95% confidence interval {CI}: 86%, 100%]; sensitivity, 30% [95% CI: 18%, 45%]) or 6-month modified Rankin scale score greater than 3 (specificity, 100% [95% CI: 73%, 100%]; sensitivity, 41% [95% CI: 29%, 54%]), with patients with poor outcomes having significantly lower ADCs for both outcome measures (P Յ .001). Differences in ADC between patients with good and those with poor outcomes varied according to brain region, involving predominantly the occipital and parietal lobes and the putamen, and were dependent on the timing of imaging. Conclusion:Spatial and temporal differences in ADCs may provide insight into mechanisms of hypoxic-ischemic brain injury and, hence, recovery. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. In comatose patients after cardiac arrest, prediction of meaningful neurologic recovery within the first several weeks can be challenging. Mortality rates with cardiac arrest range from 60% to 85%, and approximately 80% of survivors are initially comatose (1-3). Of those who survive, 50% are left with a permanent neurologic disability, and only 10% are able to resume their former lifestyle (1,2). Multiple methods have been assessed for prognostic value in this setting, including the clinical examination (3), electrophysiology with electroencephalography (4) and somatosensory evoked potentials (5), and plasma biomarkers indicative of neuronal cell death (6). Some groups (7) have looked at a combined approach with these modalities to improve the power of prognostication. However, prognostication can be achieved with very high specificity ...

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confidence: 99%

Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Sorensen²,

Benner³

et al. 2009

Radiology

169

112

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“…(Bunch et al, 2003; Hypothermia After Cardiac Arrest Study Group, 2002;Paradis et al, 2002). The increased incidence of survival presents a class of physiologic and behavioral deficits that are related to the anoxic/hypoxic state experienced during cardiac arrest/CPR (de Vos et al, 1999;Drysdale et al, 2000;Pusswald et al, 2000). Several laboratories have examined the molecular and cellular effects of cardiac arrest/CPR (Bottiger et al, 1999;Katz et al, 2001;Sadowski et al, 2002), but until recently, little was known about behavioral deficits in cardiac arrest/CPR survivors.…”

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confidence: 99%

Cardiac Arrest/Cardiopulmonary Resuscitation Increases Anxiety-Like Behavior and Decreases Social Interaction

Neigh

Kofler

Meyers

et al. 2004

J Cereb Blood Flow Metab

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SummaryAdvances in medical technology have increased the number of individuals who survive cardiac arrest/ cardiopulmonary resuscitation (CPR). This increased incidence of survival has created a population of patients with behavioral and physiologic impairments. We used temperature manipulations to characterize the contribution of central nervous system damage to behavioral deficits elicited by 8 minutes of cardiac arrest/CPR in a mouse model. Once sensorimotor deficits were resolved, we examined anxiety-like behavior with the elevated plus maze and social interaction with an ovariectomized female. We hypothesized that anxiety-like behavior would increase and social interaction would decrease in mice subjected to cardiac arrest/CPR and that these changes would be attributable to central nervous system damage rather than damage to peripheral organs or changes orchestrated by the administration of epinephrine. Mice that were subjected to cardiac arrest/CPR while the peripheral organs, but not the brain, were protected by hypothermia exhibited increased anxiety-like behavior and decreased social interaction, whereas mice with hypothermic brains and peripheral organs during cardiac arrest/CPR did not exhibit behavioral impairments. The present study demonstrates that central nervous system damage from cardiac arrest/CPR results in increased anxiety and decreased social interaction and that these behavioral changes are not attributed to underlying sensorimotor deficits, dynamics of arrest and CPR, or peripheral organ damage. KeywordsCardiac arrest; Cardiopulmonary resuscitation; Glucocorticoids; Sudden death; Anxiety; Social interaction Cardiac arrest/cardiopulmonary resuscitation (CPR) results in one death every minute in the United States and approximately 250,000 deaths per year (American Heart Association, 2002). Increased public awareness of symptoms and advances in medical technology have increased the number of individuals who survive cardiac arrest/CPR through early Address correspondence to Gretchen N. Neigh, Department of Psychology, Townshend Hall, 1885 Neil Avenue Mall, Ohio State University, Columbus, OH 43210; e-mail:neigh.1@osu.edu.. Supported by National Institutes of Health Grants NS 40267 and NS20020 and American Heart Association EIA (A.C.D.). Also supported by grants J1864-MED and J2106 from the Austrian Science Fund (Fond zur Förderung der Wissenschaftlichen Forschung) (J. Kofler). (Bunch et al., 2003; Hypothermia After Cardiac Arrest Study Group, 2002;Paradis et al., 2002). The increased incidence of survival presents a class of physiologic and behavioral deficits that are related to the anoxic/hypoxic state experienced during cardiac arrest/CPR (de Vos et al., 1999;Drysdale et al., 2000;Pusswald et al., 2000). Several laboratories have examined the molecular and cellular effects of cardiac arrest/CPR (Bottiger et al., 1999;Katz et al., 2001;Sadowski et al., 2002), but until recently, little was known about behavioral deficits in cardiac arrest/CPR survivors. NIH Public AccessThe effect of su...

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“…Survival rates are quite dismal at 23.9% and 9.5%, in-and out-of-hospital respectively [1]. Permanent neurologic damage following survival has a high incidence at greater than 50% [2]. Neurologic damage occurs through multiple mechanisms.…”

Section: Discussionmentioning

confidence: 99%

“…According to the American Heart Association (AHA), in 2013 the incidence of out-of-hospital cardiac arrest was 359,400, of which the overall survival rate was 9.5% [1], with greater than 50% of those survivors suffering the sequelae permanent neurologic deficits [2]. Neurologic damage commonly occurs through a combination of absence of cerebral oxygenation during pulselessness and reperfusion injury following return of spontaneous circulation (ROSC) [3].…”

Section: Therapeutic Hypothermia Still Effective In Prevention Of Anomentioning

confidence: 99%

Therapeutic Hypothermia Still Effective in Prevention of Anoxic Encephalopathy following Extended Period of Pulselessness during Cardiac Arrest

Nt¹,

Bray²,

Osman³

et al. 2014

Journal of Clinical and Experimental Research in Cardiology

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There are approximately 300,000 out-of-hospital cardiac arrests per year with less than 10% of those surviving. More than half of survivors suffer permanent neurologic deficits. Therapeutic hypothermia has proven effective at thwarting neurologic damage occurring in the 16-hour window following return of spontaneous circulation (ROSC). Despite recommendations by the American Heart Association (AHA), many cardiologists have been slow to implement therapeutic hypothermia. While many trials have discussed the relevance of initial rhythm and delay of cooling, there has been limited discussion of the efficacy of therapeutic hypothermia in the presence of extended pulselessness.

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Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment

Cited by 139 publications

References 21 publications

Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Cardiac Arrest/Cardiopulmonary Resuscitation Increases Anxiety-Like Behavior and Decreases Social Interaction

Therapeutic Hypothermia Still Effective in Prevention of Anoxic Encephalopathy following Extended Period of Pulselessness during Cardiac Arrest

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