Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2)

Abstract

Background This study is designed to provide detailed knowledge on cognitive impairment after out-of-hospital cardiac arrest (OHCA) and its relation to associated factors, and to validate the neurocognitive screening of the Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest trial (TTM2-trial), assessing effectiveness of targeted temperature management after OHCA. Methods This longitudinal multi-center clinical study is a sub-study of the TTM2-trial, in which a comprehensive neuropsychological examination is performed in addition to the main TTM2-trial neurocognitive screening. Approximately 7 and 24 months after OHCA, survivors at selected study sites are invited to a standardized assessment, including performance-based tests of cognition and questionnaires of emotional problems, fatigue, executive function and insomnia. At 1:1 ratio, a matched control group from a cohort of acute myocardial infarction (MI) patients is recruited to perform the same assessment. We aim to include 100 patients per group. Potential differences between the OHCA patients and the MI controls at 7 and 24 months will be analyzed with a linear regression, using composite z-scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions) as primary outcome measures. Results from OHCA survivors on the main TTM2-trial neurocognitive screening battery will be compared with neuropsychological test results at 7 months, using sensitivity and specificity analyses. Discussion In this study we collect detailed information on cognitive impairment after OHCA and compare this to a control group of patients with acute MI. The validation of the TTM2 neurocognitive screening battery could justify its inclusion in routine follow-up. Our results may have a potential to impact on the design of future follow-up strategies and interventions after OHCA. Trial registration ClinicalTrials.gov, NCT03543371. Registered 1 June 2018

Telephone-based evaluation of cognitive impairment and mood disorders in cardiac arrest survivors with good neurologic outcomes: a retrospective cohort study

“…In the present study, we used the Mini MoCA test and AD-8, which were developed and validated for patients with Alzheimer’s disease. The occurrence of cognitive impairment (23.7%) and emotional disorders (28.9%) 6 months after a cardiac arrest is consistent with previous studies 4 , 5 , 29 . Based on HADS scale, the prevalence of anxiety and depression among OHCA survivors are previously reported to be about 20–30% 28 .…”

“…Approximately 6–11% of patients who experience an out-of-hospital cardiac arrest (OHCA) are discharged with good neurological outcomes, as defined by a Cerebral Performance Category (CPC) score ≤ 2 or Modified Rankin Scale score ≤ 3 1 , 2 . However, the consequences of cardiac arrest, even in cases of favorable neurological outcomes, can limit patients’ daily activities, psychological conditions, and quality of life (QoL) 3 , 4 . Several studies have reported that OHCA survivors may be cognitively impaired, predominantly regarding memory and executive functions, and emotional problems, including anxiety and depression, during long-term follow-up 5 – 7 .…”

Neuropsychological outcome after cardiac arrest: results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial

“…This predefined case–control sub-study is a part of the international, multicenter Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial [ 12 , 13 ], in which 8 of 61 TTM2-sites participated. The study protocol has been published [ 14 ] and the study registered at ClinicalTrials.gov, NCT03543371.…”

Prognostic accuracy of head computed tomography for prediction of functional outcome after out-of-hospital cardiac arrest: Rationale and design of the prospective TTM2-CT-substudy

“… 16 Patients were treated according to the TTM2-trial protocols regarding inclusion and exclusion criteria, randomisation, clinical management, neurological prognostication, decisions on withdrawal of life-sustaining therapy (WLST) and follow-up. 20 , 22 , 23 …”