Advertisement

Cognitive and Functional Consequence of Cardiac Arrest

  • Claudia A. Perez
  • Niyatee Samudra
  • Venkatesh Aiyagari
Dementia (KS Marder, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Dementia

Abstract

Cardiac arrest is associated with high morbidity and mortality. Better-quality bystander cardiopulmonary resuscitation training, cardiocerebral resuscitation principles, and intensive post-resuscitation hospital care have improved survival. However, cognitive and functional impairment after cardiac arrest remain areas of concern. Research focus has shifted beyond prognostication in the immediate post-arrest period to identification of mechanisms for long-term brain injury and implementation of promising protocols to reduce neuronal injury. These include therapeutic temperature management (TTM), as well as pharmacologic and psychological interventions which also improve overall neurological function. Comprehensive assessment of cognitive function post-arrest is hampered by heterogeneous measures among studies. However, the domains of attention, long-term memory, spatial memory, and executive function appear to be affected. As more patients survive cardiac arrest for longer periods of time, there needs to be a greater focus on interventions that can enhance cognitive and psychosocial function post-arrest.

Keywords

Cardiac arrest Cognitive Function Dementia Hypoxic brain injury Out of hospital cardiac arrest 

Notes

Compliance with Ethics Standards

Conflict of Interest

Claudia A. Perez, Niyatee Samudra, and Venkatesh Aiyagari declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Executive summary: heart disease and stroke statistics-2016 update: a report from the American heart association. Circulation. 2016;133:447–54.CrossRefPubMedGoogle Scholar
  2. 2.
    Berdowski J, Berg RA, Tijssen JG, Koster RW. Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation. 2010;81:1479–87.CrossRefPubMedGoogle Scholar
  3. 3.
    Frohlich GM, Lyon RM, Sasson C, Crake T, Whitbread M, Indermuehle A, et al. Out-of-hospital cardiac arrest—optimal management. Curr Cardiol Rev. 2013;9:316–24.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Kellum MJ, Kennedy KW, Ewy GA. Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest. Am J Med. 2006;119:335–40.CrossRefPubMedGoogle Scholar
  5. 5.
    Blom MT, Beesems SG, Homma PC, Zijlstra JA, Hulleman M, van Hoeijen DA, et al. Improved survival after out-of-hospital cardiac arrest and use of automated external defibrillators. Circulation. 2014;130:1868–75.CrossRefPubMedGoogle Scholar
  6. 6.••
    Zhang XW, Xie JF, Chen JX, Huang YZ, Guo FM, Yang Y, et al. The effect of mild induced hypothermia on outcomes of patients after cardiac arrest: a systematic review and meta-analysis of randomised controlled trials. Crit Care. 2015;19:417. This is a meta-analysis of six RCT, which showed that mild induced hypothermia (MIH) may not improve mortality after cardiac arrest at hospital discharge, except for those who have a shockable rhythm. MIH improved neurological function at hospital discharge.CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Gao Y, Hui KL, Wang YJ, Wu L, Duan ML, Xu JG, et al. Efficacy of mild hypothermia for the treatment of patients with cardiac arrest. Chin Med J (Engl). 2015;128:1536–42.CrossRefGoogle Scholar
  8. 8.
    Maupain C, Bougouin W, Lamhaut L, Deye N, Diehl JL, Geri G, Perier MC, Beganton F, Marijon E, Jouven X, Cariou A, Dumas F. The CAHP (Cardiac Arrest Hospital Prognosis) score: a tool for risk stratification after out-of-hospital cardiac arrest. Eur Heart J. 2015.Google Scholar
  9. 9.
    Okada K, Ohde S, Otani N, Sera T, Mochizuki T, Aoki M, et al. Prediction protocol for neurological outcome for survivors of out-of-hospital cardiac arrest treated with targeted temperature management. Resuscitation. 2012;83:734–9.CrossRefPubMedGoogle Scholar
  10. 10.
    Adrie C, Cariou A, Mourvillier B, Laurent I, Dabbane H, Hantala F, et al. Predicting survival with good neurological recovery at hospital admission after successful resuscitation of out-of-hospital cardiac arrest: the OHCA score. Eur Heart J. 2006;27:2840–5.CrossRefPubMedGoogle Scholar
  11. 11.
    Phelps R, Dumas F, Maynard C, Silver J, Rea T. Cerebral performance category and long-term prognosis following out-of-hospital cardiac arrest. Crit Care Med. 2013;41:1252–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Wachelder EM, Moulaert VR, van Heugten C, Verbunt JA, Bekkers SC, Wade DT. Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest. Resuscitation. 2009;80:517–22.CrossRefPubMedGoogle Scholar
  13. 13.
    Cronberg T, Lilja G, Rundgren M, Friberg H, Widner H. Long-term neurological outcome after cardiac arrest and therapeutic hypothermia. Resuscitation. 2009;80:1119–23.CrossRefPubMedGoogle Scholar
  14. 14.
    Buanes EA, Gramstad A, Sovig KK, Hufthammer KO, Flaatten H, Husby T, et al. Cognitive function and health-related quality of life four years after cardiac arrest. Resuscitation. 2015;89:13–8.CrossRefPubMedGoogle Scholar
  15. 15.
    Sulzgruber P, Kliegel A, Wandaller C, Uray T, Losert H, Laggner AN, et al. Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning. Resuscitation. 2015;88:120–5.CrossRefPubMedGoogle Scholar
  16. 16.
    Madl C, Holzer M. Brain function after resuscitation from cardiac arrest. Curr Opin Crit Care. 2004;10:213–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Greer DM. Mechanisms of injury in hypoxic-ischemic encephalopathy: implications to therapy. Semin Neurol. 2006;26:373–9.CrossRefPubMedGoogle Scholar
  18. 18.
    Li C, Jackson RM. Reactive species mechanisms of cellular hypoxia-reoxygenation injury. Am J Physiol Cell Physiol. 2002;282:C227–41.CrossRefPubMedGoogle Scholar
  19. 19.
    Abramov AY, Scorziello A, Duchen MR. Three distinct mechanisms generate oxygen free radicals in neurons and contribute to cell death during anoxia and reoxygenation. J Neurosci. 2007;27:1129–38.CrossRefPubMedGoogle Scholar
  20. 20.
    Kaur C, Rathnasamy G, Ling EA. Roles of activated microglia in hypoxia induced neuroinflammation in the developing brain and the retina. J Neuroimmune Pharmacol. 2013;8:66–78.CrossRefPubMedGoogle Scholar
  21. 21.
    Aarts MM, Tymianski M. Molecular mechanisms underlying specificity of excitotoxic signaling in neurons. Curr Mol Med. 2004;4:137–47.CrossRefPubMedGoogle Scholar
  22. 22.
    Arundine M, Tymianski M. Molecular mechanisms of calcium-dependent neurodegeneration in excitotoxicity. Cell Calcium. 2003;34:325–37.CrossRefPubMedGoogle Scholar
  23. 23.
    Greer DM. Hypothermia for cardiac arrest. Curr Neurol Neurosci Rep. 2006;6:518–24.CrossRefPubMedGoogle Scholar
  24. 24.
    Chen GJ, Xu J, Lahousse SA, Caggiano NL, de la Monte SM. Transient hypoxia causes Alzheimer-type molecular and biochemical abnormalities in cortical neurons: potential strategies for neuroprotection. J Alzheimers Dis. 2003;5:209–28.PubMedGoogle Scholar
  25. 25.
    Villarreal AE, Barron R, Rao KS, Britton GB. The effects of impaired cerebral circulation on Alzheimer’s disease pathology: evidence from animal studies. J Alzheimers Dis. 2014;42:707–22.PubMedGoogle Scholar
  26. 26.••
    Pluta R, Kocki J, Ulamek-Koziol M, Bogucka-Kocka A, Gil-Kulik P, Januszewski S, et al. Alzheimer-associated presenilin 2 gene is dysregulated in rat medial temporal lobe cortex after complete brain ischemia due to cardiac arrest. Pharmacol Rep. 2016;68:155–61. Animal model study which showed dysregulation of presenilin 2 gene expression in global brain ischemia from cardiac arrest. Ischemia induced gene dysregulation may play a role in late onset Alzheimer’s-type dementia.CrossRefPubMedGoogle Scholar
  27. 27.
    Maslinska D, Laure-Kamionowska M, Taraszewska A, Deregowski K, Maslinski S. Immunodistribution of amyloid beta protein (Abeta) and advanced glycation end-product receptors (RAGE) in choroid plexus and ependyma of resuscitated patients. Folia Neuropathol. 2011;49:295–300.PubMedGoogle Scholar
  28. 28.
    Muche A, Burger S, Arendt T, Schliebs R. Hypoxic stress, brain vascular system, and beta-amyloid: a primary cell culture study. Nutr Neurosci. 2015;18:1–11.CrossRefPubMedGoogle Scholar
  29. 29.
    Bjorklund E, Lindberg E, Rundgren M, Cronberg T, Friberg H, Englund E. Ischaemic brain damage after cardiac arrest and induced hypothermia—a systematic description of selective eosinophilic neuronal death. A neuropathologic study of 23 patients. Resuscitation. 2014;85:527–32.CrossRefPubMedGoogle Scholar
  30. 30.
    Zola-Morgan S, Squire LR, Amaral DG. Human amnesia and the medial temporal region: enduring memory impairment following a bilateral lesion limited to field CA1 of the hippocampus. J Neurosci. 1986;6:2950–67.PubMedGoogle Scholar
  31. 31.
    Petito CK, Feldmann E, Pulsinelli WA, Plum F. Delayed hippocampal damage in humans following cardiorespiratory arrest. Neurology. 1987;37:1281–6.CrossRefPubMedGoogle Scholar
  32. 32.
    Brierley JB, Graham DI, Adams JH, Simpsom JA. Neocortical death after cardiac arrest. A clinical, neurophysiological, and neuropathological report of two cases. Lancet. 1971;2:560–5.PubMedGoogle Scholar
  33. 33.
    Whitwell JL, Petersen RC, Negash S, Weigand SD, Kantarci K, Ivnik RJ, et al. Patterns of atrophy differ among specific subtypes of mild cognitive impairment. Arch Neurol. 2007;64:1130–8.CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Duara R, Loewenstein DA, Potter E, Appel J, Greig MT, Urs R, et al. Medial temporal lobe atrophy on MRI scans and the diagnosis of Alzheimer disease. Neurology. 2008;71:1986–92.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Grubb NR, Fox KA, Smith K, Best J, Blane A, Ebmeier KP, et al. Memory impairment in out-of-hospital cardiac arrest survivors is associated with global reduction in brain volume, not focal hippocampal injury. Stroke. 2000;31:1509–14.CrossRefPubMedGoogle Scholar
  36. 36.
    Nunes B, Pais J, Garcia R, Magalhaes Z, Granja C, Silva MC. Cardiac arrest: long-term cognitive and imaging analysis. Resuscitation. 2003;57:287–97.CrossRefPubMedGoogle Scholar
  37. 37.
    Markowitsch HJ, Weber-Luxemburger G, Ewald K, Kessler J, Heiss WD. Patients with heart attacks are not valid models for medial temporal lobe amnesia. A neuropsychological and FDG-PET study with consequences for memory research. Eur J Neurol. 1997;4:178–84.CrossRefPubMedGoogle Scholar
  38. 38.
    Roine RO, Raininko R, Erkinjuntti T, Ylikoski A, Kaste M. Magnetic resonance imaging findings associated with cardiac arrest. Stroke. 1993;24:1005–14.CrossRefPubMedGoogle Scholar
  39. 39.
    Levy DE, Caronna JJ, Singer BH, Lapinski RH, Frydman H, Plum F. Predicting outcome from hypoxic-ischemic coma. JAMA. 1985;253:1420–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Moulaert Vé RM, van Haastregt JCM, Wade DT, van Heugten CM, Verbunt JA. ‘Stand still …, move on’, an early neurologically-focused follow-up for cardiac arrest survivors and their caregivers: a process evaluation. BMC Health Serv Res. 2014;14:34.CrossRefGoogle Scholar
  41. 41.
    Moulaert VR, Verbunt JA, van Heugten CM, Wade DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2009;80:297–305.CrossRefPubMedGoogle Scholar
  42. 42.
    van Alem AP, de Vos R, Schmand B, Koster RW. Cognitive impairment in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148:416–21.CrossRefPubMedGoogle Scholar
  43. 43.
    Rankin J. Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J. 1957;2:200–15.PubMedGoogle Scholar
  44. 44.
    Ajam K, Gold LS, Beck SS, Damon S, Phelps R, Rea TD. Reliability of the cerebral performance category to classify neurological status among survivors of ventricular fibrillation arrest: a cohort study. Scand J Trauma Resusc Emerg Med. 2011;19:38.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Rittenberger JC, Raina K, Holm MB, Kim YJ, Callaway CW. Association between cerebral performance category, modified Rankin scale, and discharge disposition after cardiac arrest. Resuscitation. 2011;82:1036–40.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Stiell IG, Nesbitt LP, Nichol G, Maloney J, Dreyer J, Beaudoin T, et al. Comparison of the cerebral performance category score and the health utilities index for survivors of cardiac arrest. Ann Emerg Med. 2009;53:241–8.CrossRefPubMedGoogle Scholar
  47. 47.
    Lim C, Alexander MP, LaFleche G, Schnyer DM, Verfaellie M. The neurological and cognitive sequelae of cardiac arrest. Neurology. 2004;63:1774–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Grubb NR, O’Carroll R, Cobbe SM, Sirel J, Fox KA. Chronic memory impairment after cardiac arrest outside hospital. BMJ. 1996;313:143–6.CrossRefPubMedPubMedCentralGoogle Scholar
  49. 49.
    Drysdale EE, Grubb NR, Fox KA, O’Carroll RE. Chronicity of memory impairment in long-term out-of-hospital cardiac arrest survivors. Resuscitation. 2000;47:27–32.CrossRefPubMedGoogle Scholar
  50. 50.
    Greene JD, Baddeley AD, Hodges JR. Analysis of the episodic memory deficit in early Alzheimer’s disease: evidence from the doors and people test. Neuropsychologia. 1996;34:537–51.CrossRefPubMedGoogle Scholar
  51. 51.
    Mateen FJ, Josephs KA, Trenerry MR, Felmlee-Devine MD, Weaver AL, Carone M, et al. Long-term cognitive outcomes following out-of-hospital cardiac arrest: a population-based study. Neurology. 2011;77:1438–45.CrossRefPubMedGoogle Scholar
  52. 52.
    Roine RO, Kajaste S, Kaste M. Neuropsychological sequelae of cardiac arrest. JAMA. 1993;269:237–42.CrossRefPubMedGoogle Scholar
  53. 53.
    Sauve MJ, Walker JA, Massa SM, Winkle RA, Scheinman MM. Patterns of cognitive recovery in sudden cardiac arrest survivors: the pilot study. Heart Lung. 1996;25:172–81.CrossRefPubMedGoogle Scholar
  54. 54.
    Orbo M, Aslaksen PM, Larsby K, Schafer C, Tande PM, Vangberg TR, et al. Relevance of cognition to health-related quality of life in good-outcome survivors of out-of-hospital cardiac arrest. J Rehabil Med. 2015;47:860–6.CrossRefPubMedGoogle Scholar
  55. 55.
    Lilja G, Nilsson G, Nielsen N, Friberg H, Hassager C, Koopmans M, et al. Anxiety and depression among out-of-hospital cardiac arrest survivors. Resuscitation. 2015;97:68–75.CrossRefPubMedGoogle Scholar
  56. 56.••
    Pachys G, Kaufman N, Bdolah-Abram T, Kark JD, Einav S. Predictors of long-term survival after out-of-hospital cardiac arrest: the impact of activities of daily living and cerebral performance category scores. Resuscitation. 2014;85:1052–8. This study presented prospective data in assessing outcomes for n = 1043 Israeli out-of-hospital cardiac arrest patients. 18.6% of these patients survived. Of these, 1/3 died within 30 months of the arrest. Of those who survived, long-term survival was positively correlated with lower CPC scores and less worsening in activities of daily living from before the arrest to hospital discharge. Most frequently, long-term survival in this cohort was associated with less deterioration in functional status and activities of daily living.CrossRefPubMedGoogle Scholar
  57. 57.
    Hsu JW, Madsen CD, Callaham ML. Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcome scales. Ann Emerg Med. 1996;28:597–605.CrossRefPubMedGoogle Scholar
  58. 58.
    Elliott VJ, Rodgers DL, Brett SJ. Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival. Resuscitation. 2011;82:247–56.CrossRefPubMedGoogle Scholar
  59. 59.••
    Smith K, Andrew E, Lijovic M, Nehme Z, Bernard S. Quality of life and functional outcomes 12 months after out-of-hospital cardiac arrest. Circulation. 2015;131:174–81. A large study (n = 697) which looked at functional outcomes in cardiac arrest survivors after one year. Provides good evidence that that many survivors have a good quality of life 12 months post-arrest when compared to population.CrossRefPubMedGoogle Scholar
  60. 60.
    Nichol G, Guffey D, Stiell IG, Leroux B, Cheskes S, Idris A, Kudenchuk PJ, Macphee RS, Wittwer L, Rittenberger JC, Rea TD, Sheehan K, Rac VE, Raina K, Gorman K, Aufderheide T. Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: a ROC PRIMED substudy. Resuscitation 93:74–81.Google Scholar
  61. 61.
    Kragholm K, Wissenberg M, Mortensen RN, Fonager K, Jensen SE, Rajan S, et al. Return to work in out-of-hospital cardiac arrest survivors: a nationwide register-based follow-up study. Circulation. 2015;131:1682–90.CrossRefPubMedGoogle Scholar
  62. 62.
    Larsson IM, Wallin E, Rubertsson S, Kristofferzon ML. Health-related quality of life improves during the first six months after cardiac arrest and hypothermia treatment. Resuscitation. 2014;85:215–20.CrossRefPubMedGoogle Scholar
  63. 63.
    Stiell I, Nichol G, Wells G, De Maio V, Nesbitt L, Blackburn J, et al. Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation. 2003;108:1939–44.CrossRefPubMedGoogle Scholar
  64. 64.
    van Alem AP, Waalewijn RA, Koster RW, de Vos R. Assessment of quality of life and cognitive function after out-of-hospital cardiac arrest with successful resuscitation. Am J Cardiol. 2004;93:131–5.CrossRefPubMedGoogle Scholar
  65. 65.
    Pusswald G, Fertl E, Faltl M, Auff E. Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment. Resuscitation. 2000;47:241–8.CrossRefPubMedGoogle Scholar
  66. 66.
    Green CR, Botha JA, Tiruvoipati R. Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review. Anaesth Intensive Care. 2015;43:568–76.PubMedGoogle Scholar
  67. 67.••
    Wilder Schaaf KP, Artman LK, Peberdy MA, Walker WC, Ornato JP, Gossip MR, et al. Anxiety, depression, and PTSD following cardiac arrest: a systematic review of the literature. Resuscitation. 2013;84:873–7. A systematic review which showed high rates of psychological distress after OHCA. Incidence rates of depression ranged from 14% to 45%; anxiety rates from 13% to 61%; PTSD rates from 19% to 27%. Highlights need for psychological screening and early intervention and further study of incidence in inpatient and outpatient setting.CrossRefPubMedGoogle Scholar
  68. 68.
    Deasy C, Bray J, Smith K, Harriss L, Bernard S, Cameron P. Functional outcomes and quality of life of young adults who survive out-of-hospital cardiac arrest. Emerg Med J. 2013;30:532–7.CrossRefPubMedGoogle Scholar
  69. 69.
    Wilson M, Staniforth A, Till R, das Nair R, Vesey P. The psychosocial outcomes of anoxic brain injury following cardiac arrest. Resuscitation. 2014;85:795–800.CrossRefPubMedGoogle Scholar
  70. 70.
    Parnia S, Spearpoint K, Fenwick PB. Near death experiences, cognitive function and psychological outcomes of surviving cardiac arrest. Resuscitation. 2007;74:215–21.CrossRefPubMedGoogle Scholar
  71. 71.
    Hypothermia after Cardiac Arrest Study G. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–56.CrossRefGoogle Scholar
  72. 72.
    Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–63.CrossRefPubMedGoogle Scholar
  73. 73.
    Tiainen M, Poutiainen E, Kovala T, Takkunen O, Happola O, Roine RO. Cognitive and neurophysiological outcome of cardiac arrest survivors treated with therapeutic hypothermia. Stroke. 2007;38:2303–8.CrossRefPubMedGoogle Scholar
  74. 74.••
    Nielsen N, Wetterslev J, Cronberg T, Erlinge D, Gasche Y, Hassager C, et al. Targeted temperature management at 33 degrees C versus 36 degrees C after cardiac arrest. N Engl J Med. 2013;369:2197–206. This is international trial, of randomly assigned unconscious survivors of out of hospital cardiac arrest(OHCA), n = 939, to either TTM of 33 degrees C or 36 degrees C. The study did not show benefit of hypothermia in mortality through the end of trial period or neurological function at 180 day-follow up.CrossRefPubMedGoogle Scholar
  75. 75.
    Alexander MP, Lafleche G, Schnyer D, Lim C, Verfaellie M. Cognitive and functional outcome after out of hospital cardiac arrest. J Int Neuropsychol Soc. 2011;17:364–8.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Kida K, Shirozu K, Yu B, Mandeville JB, Bloch KD, Ichinose F. Beneficial effects of nitric oxide on outcomes after cardiac arrest and cardiopulmonary resuscitation in hypothermia-treated mice. Anesthesiology. 2014;120:880–9.CrossRefPubMedPubMedCentralGoogle Scholar
  77. 77.
    Minamishima S, Bougaki M, Sips PY, Yu JD, Minamishima YA, Elrod JW, et al. Hydrogen sulfide improves survival after cardiac arrest and cardiopulmonary resuscitation via a nitric oxide synthase 3-dependent mechanism in mice. Circulation. 2009;120:888–96.CrossRefPubMedPubMedCentralGoogle Scholar
  78. 78.••
    Laitio R, Hynninen M, Arola O, Virtanen S, Parkkola R, Saunavaara J, et al. Effect of inhaled xenon on cerebral white matter damage in comatose survivors of out-of-hospital cardiac arrest: a randomized clinical trial. JAMA. 2016;315:1120–8. This is a randomized controlled trial of 110 comatose patients assigned to receive either hypothermia alone or hypothermia with xenon. The primary outcome was cerebral white matter damage by fractional anisotropy from diffusion tensor MRI between 36 - 52 hours after cardiac arrest. Secondary endpoints were neurologic outcome (mRS) and mortality. Although xenon showed benefit over hypothermia alone in terms of less white matter damage, there was not a statistically significant difference in mRS or mortality at 6 months.CrossRefPubMedGoogle Scholar
  79. 79.
    Huang L, Applegate PM, Gatling JW, Mangus DB, Zhang J, Applegate 2nd RL. A systematic review of neuroprotective strategies after cardiac arrest: from bench to bedside (part II-comprehensive protection). Med Gas Res. 2014;4:10.CrossRefPubMedPubMedCentralGoogle Scholar
  80. 80.••
    Moulaert VR, van Heugten CM, Winkens B, Bakx WG, de Krom MC, Gorgels TP, et al. Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial. Int J Cardiol. 2015;193:8–16. A nursing intervention was developed specifically for the purpose of improving neurologic and emotional health related outcomes for cardiac arrest survivors and caregivers (n = 185 and 155 respectively). Improvement in multiple SF-36 domains was assessed at different time points (2 weeks, 3 months, and 12 months). The group that received the intervention experienced improvement in overall emotional state and anxiety after a year. Additionally, at 3 months more people in the intervention group were back at work.CrossRefPubMedGoogle Scholar
  81. 81.
    Huang Y, He Q, Yang LJ, Liu GJ, Jones A. Cardiopulmonary resuscitation (CPR) plus delayed defibrillation versus immediate defibrillation for out-of-hospital cardiac arrest. Cochrane Database Syst Rev. 2014;9:Cd009803.PubMedGoogle Scholar
  82. 82.
    Brooks SC, Hassan N, Bigham BL, Morrison LJ. Mechanical versus manual chest compressions for cardiac arrest. Cochrane Database Syst Rev. 2014;2:Cd007260.PubMedGoogle Scholar
  83. 83.
    Aufderheide TP, Frascone RJ, Wayne MA, Mahoney BD, Swor RA, Domeier RM, et al. Standard cardiopulmonary resuscitation versus active compression-decompression cardiopulmonary resuscitation with augmentation of negative intrathoracic pressure for out-of-hospital cardiac arrest: a randomised trial. Lancet. 2011;377:301–11.CrossRefPubMedPubMedCentralGoogle Scholar
  84. 84.
    Becker LB, Aufderheide TP, Geocadin RG, Callaway CW, Lazar RM, Donnino MW, et al. Primary outcomes for resuscitation science studies: a consensus statement from the American Heart Association. Circulation. 2011;124:2158–77.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Claudia A. Perez
    • 1
    • 2
  • Niyatee Samudra
    • 2
  • Venkatesh Aiyagari
    • 1
    • 2
  1. 1.Department of Neurological SurgeryUT Southwestern Medical CenterDallasUSA
  2. 2.Department of Neurology and NeurotherapeuticsUT Southwestern Medical CenterDallasUSA

Personalised recommendations