Cognitive and Functional Consequence of Cardiac Arrest
- 608 Downloads
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.
KeywordsCardiac arrest Cognitive Function Dementia Hypoxic brain injury Out of hospital cardiac arrest
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.
Papers of particular interest, published recently, have been highlighted as: •• Of major importance
- 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
- 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
- 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
- 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
- 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
- 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.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
- 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
- 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
- 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
- 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
- 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