Neurocognitive outcomes following successful resuscitation from cardiac arrest

• Published in: Resuscitation 2015-05, Vol.90, p.67-72
• Main Authors: Sabedra, Alexa R, Kristan, Jeffrey, Raina, Ketki, Holm, Margo B, Callaway, Clifton W, Guyette, Francis X, Dezfulian, Cameron, Doshi, Ankur A, Rittenberger, Jon C
• Format: Article
• Language: English
• Subjects: Cardiopulmonary Resuscitation; Cognition; Coma - etiology; Coma - therapy; Critical care; Emergency; Female; Heart arrest; Heart Arrest - therapy; Humans; Hypothermia; Male; Middle Aged; Neuropsychological Tests; Patient outcome assessment; Prospective Studies; Resuscitation; Survivors
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2015.02.023

Abstract Introduction Cardiac arrest commonly results in varying degrees of cognitive injury. Standard outcome measures used in the cardiac arrest cohort do not rigorously evaluate for these injury patterns. We examined the utility of the Computerized Assessment for Mild Cognitive Injury (CAMCI) in cardiac arrest (CA) survivors. We hypothesized that cognitive deficits would be more severe in patients who were comatose on hospital arrival. Methods Prospective cohort of CA survivors at a single tertiary care facility where participants received neurocognitive testing using CAMCI. CAMCI results were subdivided into memory, attention, and executive functions. Scores between subjects who were initially comatose and were not comatose following resuscitation were compared using the Mann–Whitney test. Results Of 72 subjects included, the majority ( N = 44) were initially comatose following resuscitation with mean age of 54 (±14) years. The majority experienced a good neurologic outcome based on Cerebral Performance Category ( N = 47; 66%) and Modified Rankin Scale ( N = 38; 53%). Time from resuscitation to CAMCI testing was not associated with total CAMCI score in this cohort (Pearson's r2 value −0.1941, p = 0.20). Initially comatose and not comatose subjects did not differ in their CAMCI overall scores ( p = 0.33), or in any subtest areas. The not comatose cohort had 1 subtest for which there was a Moderate Risk for mild cognitive impairment (Nonverbal Accuracy), and 2 for which there was a Moderately Low Risk (Verbal Accuracy and Executive Accuracy). The Comatose cohort had 4 subtests, which were deemed Moderately Low Risk for cognitive impairment (Verbal Accuracy, Attention Accuracy, Executive Accuracy and Nonverbal Accuracy). Conclusions In-hospital CAMCI testing suggests memory, attention and executive impairment are commonly in patients following resuscitation from cardiac arrest. Outcome evaluations should test for deficits in memory, attention, and executive function.