1
|
Grasner JT, Bray JE, Nolan JP, Iwami T, Ong MEH, Finn J, McNally B, Nehme Z, Sasson C, Tijssen J, Lim SL, Tjelmeland I, Wnent J, Dicker B, Nishiyama C, Doherty Z, Welsford M, Perkins GD. Cardiac arrest and cardiopulmonary resuscitation outcome reports: 2024 update of the Utstein Out-of-Hospital Cardiac Arrest Registry template. Resuscitation 2024:110288. [PMID: 39045606 DOI: 10.1016/j.resuscitation.2024.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
The Utstein Out-of-Hospital Cardiac Arrest Resuscitation Registry Template, introduced in 1991 and updated in 2004 and 2015, standardizes data collection to enable research, evaluation, and comparisons of systems of care. The impetus for the current update stemmed from significant advances in the field and insights from registry development and regional comparisons. This 2024 update involved representatives of the International Liaison Committee on Resuscitation and used a modified Delphi process. Every 2015 Utstein data element was reviewed for relevance, priority (core or supplemental), and improvement. New variables were proposed and refined. All changes were voted on for inclusion. The 2015 domains-system, dispatch, patient, process, and outcomes-were retained. Further clarity is provided for the definitions of out-of-hospital cardiac arrest attended resuscitation and attempted resuscitation. Changes reflect advancements in dispatch, early response systems, and resuscitation care, as well as the importance of prehospital outcomes. Time intervals such as emergency medical service response time now emphasize precise reporting of the times used. New flowcharts aid the reporting of system effectiveness for patients with an attempted resuscitation and system efficacy for the Utstein comparator group. Recognizing the varying capacities of emergency systems globally, the writing group provided a minimal dataset for settings with developing emergency medical systems. Supplementary variables are considered useful for research purposes. These revisions aim to elevate data collection and reporting transparency by registries and researchers and to advance international comparisons and collaborations. The overarching objective remains the improvement of outcomes for patients with out-of-hospital cardiac arrest.
Collapse
|
2
|
Jensen MK, Christensen J, Zarifkar P, Thygesen LC, Wieghorst A, Berg SK, Hassager C, Stenbæk DS, Wagner MK. Evaluating neurocognitive outcomes in out-of-hospital cardiac arrest survivors: A comparative study of performance-based and reported measures. Resuscitation 2024; 202:110310. [PMID: 38996907 DOI: 10.1016/j.resuscitation.2024.110310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/14/2024]
Abstract
AIMS To (1) describe the prevalence of cognitive dysfunctions using performance-based and reported measures, and (2) explore the correlations between selected performance-based, patient-reported, and observer-reported neurocognitive outcome measures three months after hospital discharge in a population of out-of-hospital cardiac arrest (OHCA) survivors. METHODS Data from 193 OHCA survivors was derived from the Danish multicenter REVIVAL cohort study. At three months, four subtests of the performance-based Delis-Kaplan Executive Function System (D-KEFS) (Trail making, Color-word interference, Verbal fluency, and Figure design), the patient-reported Behavior Rating Inventory of Executive Function - Adult (BRIEF-A), and the observer-reported 16-item Short Form (SF) Informant Questionnaire on Cognitive Decline after Cardiac Arrest (SF-16 IQCODE-CA) were collected. Spearman's rank coefficient correlation analysis was performed to examine correlations between D-KEFS, BRIEF-A, and SF-16 IQCODE-CA. RESULTS Overall, 21% of survivors exhibited impairment in executive functioning using the D-KEFS subtest Color-word interference, while only 9% self-reported executive impairment (BRIEF-A) and 7% of relatives reported cognitive decline (SF-16 IQCODE-CA) in survivors at three months post-arrest. All correlations between D-KEFS, BRIEF-A and SF-16 IQCODE-CA were negligible to low. CONCLUSION The results of this REVIVAL substudy suggest that although the performance-based and reported measures did not correlate, dual neurocognitive screening tools containing both a self-reported and an informant-reported version may have the potential to detect executive discrepancies in the return to everyday life and guide targeted neurorehabilitation after OHCA.
Collapse
Affiliation(s)
- Mie Klarskov Jensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Pardis Zarifkar
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Anders Wieghorst
- Department of Psychology, University of Southern Denmark, Odense, Denmark; REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| |
Collapse
|
3
|
Zarifkar P, Wagner MK, Fisher PM, Stenbæk DS, Berg SK, Knudsen GM, Benros ME, Kondziella D, Hassager C. Brain network changes and cognitive function after cardiac arrest. Brain Commun 2024; 6:fcae174. [PMID: 39045091 PMCID: PMC11264146 DOI: 10.1093/braincomms/fcae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/17/2024] [Accepted: 05/22/2024] [Indexed: 07/25/2024] Open
Abstract
Survival rates after out-of-hospital cardiac arrest have improved over the past two decades. Despite this progress, long-term cognitive impairment remains prevalent even in those with early recovery of consciousness after out-of-hospital cardiac arrest; however, little is known about the determinants and underlying mechanisms. We utilized the REcovery after cardiac arrest surVIVAL cohort of out-of-hospital cardiac arrest survivors who fully regained consciousness to correlate cognition measurements with brain network changes using resting-state functional MRI and the Montreal Cognitive Assessment at hospital discharge and a comprehensive neuropsychological assessment at three-month follow-up. About half of out-of-hospital cardiac arrest survivors displayed cognitive impairments at discharge, and in most, cognitive deficits persisted at three-month follow-up, particularly in the executive and visuospatial functions. Compared to healthy controls, out-of-hospital cardiac arrest survivors exhibited increased connectivity between resting-state networks, particularly involving the frontoparietal network. The increased connectivity between the frontoparietal and visual networks was associated with less favourable cognitive outcomes (β = 14.0, P = 0.01), while higher education seemed to confer some cognitive protection (β = -2.06, P = 0.03). In sum, the data highlight the importance of subtle cognitive impairment, also in out-of-hospital cardiac arrest survivors who are eligible for home discharge, and the potential of functional MRI to identify alterations in brain networks correlating with cognitive outcomes.
Collapse
Affiliation(s)
- Pardis Zarifkar
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Patrick MacDonald Fisher
- Department of Drug Design and Pharmacology, University of Copenhagen, 2100 Copenhagen, Denmark
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Psychology, Faculty of Social Sciences, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Gitte Moos Knudsen
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Michael E Benros
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
- Copenhagen Research Centre for Biological and Precision Psychiatry, Mental Health Centre Copenhagen, Copenhagen University Hospital, 2870 Copenhagen, Denmark
| | - Daniel Kondziella
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, 2100 Copenhagen, Denmark
| |
Collapse
|
4
|
Bradfield M, Haywood KL, Mion M, Kayani A, Leckey S. Not just surviving: Towards a quality standard which meets the care and rehabilitation needs of cardiac arrest survivors and their key supporters. Resuscitation 2024; 198:110182. [PMID: 38492715 DOI: 10.1016/j.resuscitation.2024.110182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/07/2024] [Accepted: 03/08/2024] [Indexed: 03/18/2024]
Affiliation(s)
- M Bradfield
- Resuscitation Council UK, United Kingdom; Faculty of Health and Social Sciences, Bournemouth University, Dorset, United Kingdom; RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom.
| | - K L Haywood
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, United Kingdom
| | - M Mion
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom; Faculty of Health, Education, Medicine and Social Care, Anglia Ruskin School of Medicine, Chelmsford, Essex, United Kingdom
| | - A Kayani
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom
| | - S Leckey
- RCUK Quality Standards Group for Care and Rehabilitation of Cardiac Arrest Survivors and Key Supporters - Lay Representative and Cardiac Arrest Survivor, United Kingdom; Northern Ireland Ambulance Service, Belfast, Northern Ireland
| |
Collapse
|
5
|
Southern C, Tutton E, Dainty KN, Seers K, Pearson NA, Couper K, Ellard DR, Perkins GD, Haywood KL. The experiences of cardiac arrest survivors and their key supporters following cardiac arrest: A systematic review and meta-ethnography. Resuscitation 2024; 198:110188. [PMID: 38548009 DOI: 10.1016/j.resuscitation.2024.110188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
AIM To review qualitative studies on the experience of sudden cardiac arrest survival from the perspective of both survivors and their key supporters, including family/close friends. METHODS A seven-step meta-ethnography and synthesis of qualitative evidence was undertaken, informed by the Meta-Ethnography Reporting Guidelines (eMERGe). Four major databases were searched (Medline, EMBASE, CINAHL, PsycINFO; January 1995-January 2022, updated July 2023) for qualitative studies exploring survivors' and/or key supporters' experiences of cardiac arrest survival. The Critical Appraisal Skills Programme checklist and Grading of Recommendations Assessment, Development and Evaluation - Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) were applied to evaluate the overall confidence in research findings. Constructs were identified from each paper, informing theme and sub-theme development. RESULTS From 15,917 unique titles/abstracts and 196 full-text articles, 32 met the inclusion criteria. Three themes captured the survivors' experiences: 1) Making sense of my cardiac arrest; 2) Learning to trust my body and mind; and 3) Re-evaluating my life. A further three themes reflected key supporters' experiences: 1) Emotional turmoil; 2) Becoming a carer: same person but different me; and 3) Engaging with a new and unknown world. However, limited data and some methodological weaknesses in included studies reduced confidence in several themes. The findings were conceived within the overarching concept of 'negotiating a new normal'. CONCLUSIONS The enduring psychosocial and physical sequelae of cardiac arrest survival substantially impacts the lives of survivors and their key supporters, requiring negotiation of their 'new normality'. The need for sense-making, physical and psychological recovery, and the new roles for key supporters should be strong considerations in the development of future interventions.
Collapse
Affiliation(s)
- Charlotte Southern
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Elizabeth Tutton
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England; Kadoorie, Oxford Trauma Research and Emergency Care, NDORMS, Oxford University, UK; Major Trauma Unit, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford UK
| | - Katie N Dainty
- Office of Research & Innovation, North York General Hospital, Toronto Ontario Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Kate Seers
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Nathan A Pearson
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England
| | - Keith Couper
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England; Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - David R Ellard
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, England; University Hospitals Coventry and Warwickshire, Clifford Bridge Road, Coventry CV2 2DX, UK
| | - Gavin D Perkins
- Critical Care Unit, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Kirstie L Haywood
- Warwick Research in Nursing, Division of Health Sciences, Warwick Medical School, University of Warwick, England.
| |
Collapse
|
6
|
Ikeda T, Kawabori M, Zheng Y, Yamaguchi S, Gotoh S, Nakahara Y, Yoshie E, Fujimura M. Intranasal Administration of Mesenchymal Stem Cell-Derived Exosome Alleviates Hypoxic-Ischemic Brain Injury. Pharmaceutics 2024; 16:446. [PMID: 38675108 PMCID: PMC11053690 DOI: 10.3390/pharmaceutics16040446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Hypoxic-ischemic brain injury arises from inadequate oxygen delivery to the brain, commonly occurring following cardiac arrest, which lacks effective treatments. Recent studies have demonstrated the therapeutic potential of exosomes released from mesenchymal stem cells. Given the challenge of systemic dilution associated with intravenous administration, intranasal delivery has emerged as a promising approach. In this study, we investigate the effects of intranasally administered exosomes in an animal model. Exosomes were isolated from the cell supernatants using the ultracentrifugation method. Brain injury was induced in Sprague-Dawley rats through a transient four-vessel occlusion model. Intranasal administration was conducted with 3 × 108 exosome particles in 20 µL of PBS or PBS alone, administered daily for 7 days post-injury. Long-term cognitive behavioral assessments, biodistribution of exosomes, and histological evaluations of apoptosis and neuroinflammation were conducted. Exosomes were primarily detected in the olfactory bulb one hour after intranasal administration, subsequently distributing to the striatum and midbrain. Rats treated with exosomes exhibited substantial improvement in cognitive function up to 28 days after the insult, and demonstrated significantly fewer apoptotic cells along with higher neuronal cell survival in the hippocampus. Exosomes were found to be taken up by microglia, leading to a decrease in the expression of cytotoxic inflammatory markers.
Collapse
Affiliation(s)
- Takuma Ikeda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Masahito Kawabori
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Yuyuan Zheng
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Sho Yamaguchi
- Regenerative Medicine and Cell Therapy Laboratories, Kaneka, Kobe 650-0047, Hyogo, Japan;
| | - Shuho Gotoh
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Yo Nakahara
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Erika Yoshie
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| | - Miki Fujimura
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Hokkaido, Japan; (T.I.); (Y.Z.); (S.G.); (Y.N.); (E.Y.); (M.F.)
| |
Collapse
|
7
|
Christensen J, Winkel BG, Kirkeskov L, Folke F, Winther-Jensen M, Eckhardt-Bentsen C, Kjærgaard J, Hassager C, Wagner MK. The ROCK trial-a multidisciplinary Rehabilitation intervention for sudden Out-of-hospital Cardiac arrest survivors focusing on return-to-worK: a pragmatic randomized controlled trial protocol. Trials 2024; 25:99. [PMID: 38303019 PMCID: PMC10835971 DOI: 10.1186/s13063-024-07911-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Most cardiac arrest survivors are classified with mild to moderate cognitive impairment; roughly, 50% experience long-term neurocognitive impairment. Postarrest challenges complicate participation in society and are associated with social issues such as failure to resume social activities and impaired return to work. The effectiveness of rehabilitation interventions for out-of-hospital cardiac arrest survivors are sparsely described, but the body of evidence describes high probabilities of survivors not returning to work, returning to jobs with modified job descriptions, returning to part-time employment, and often in combination with extensive unmet rehabilitation needs. Hence, there is a need to develop and test a pragmatic individual targeted intervention to facilitate return to work (RTW) in survivors of OHCA. The overall aim of the ROCK trial is to evaluate the effectiveness of a comprehensive individually tailored multidisciplinary rehabilitation intervention for survivors of OHCA on RTW compared to usual care. METHODS AND ANALYSIS The ROCK trial is a two-arm parallel group multicentre investigator-initiated pragmatic randomized controlled superiority trial with primary endpoint measured 12 months after the cardiac arrest. Adult survivors who were part of the labour force prior to the OCHA and had at least 2 years until they are qualified to receive retirement state pensions are eligible for inclusion. Survivors will be randomized 1:1 to usual care group or usual care plus a comprehensive tailored rehabilitation intervention focusing on supporting RTW. After comprehensive assessment of individual rehabilitation needs, the intervention is ongoingly coordinated within a multidisciplinary rehabilitation team, and the intervention can be delivered for up until 12 months. Data for the primary outcome will be obtained from the national register on social transfer payments. The primary outcome will be analysed using logistic regression assessing RTW status at 12 months adjusting for the intervention and age at OHCA, sex, marital status, and occupation prior to OHCA. DISCUSSION The ROCK trial is the first RCT to investigate the effectiveness of a rehabilitation intervention focusing on return to work after cardiac arrest. TRIAL REGISTRATION ClinicalTrials.gov NCT05173740. Registered on May 2018.
Collapse
Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital-Rigshospitalet, 2100, Copenhagen, Denmark.
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Bo Gregers Winkel
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| | - Lilli Kirkeskov
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte Hospital, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Matilde Winther-Jensen
- Department of Data, Biostatistics and Pharmacoepidemiology, Center for Clinical Research and Prevention, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christine Eckhardt-Bentsen
- Center of Social Medicine, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
8
|
Wagner MK, Berg SK, Hassager C, Borregaard B, Rasmussen TB, Ekholm O, Stenbæk DS. Cognitive impairment and psychopathology in sudden out-of-hospital cardiac arrest survivors: Results from the REVIVAL cohort study. Resuscitation 2023; 192:109984. [PMID: 37797716 DOI: 10.1016/j.resuscitation.2023.109984] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 09/11/2023] [Accepted: 09/24/2023] [Indexed: 10/07/2023]
Abstract
AIM To investigate cognitive impairment and psychopathology in out-of-hospital cardiac arrest (OHCA) survivors using a screening procedure during hospitalisation and examine the evolution of these parameters at three-month follow-up. METHODS This multicentre cohort study screened for cognitive impairment using the Montreal Cognitive Assessment (MoCA), for symptoms of anxiety, depression and traumatic distress using the Hospital Anxiety and Depression Scale (HADS) and the Impact of Event Scale-revised (IES-R) during hospitalisation. At three-month follow-up, we evaluated cognitive impairment with a neuropsychological test battery and symptoms of psychopathology were re-assessed using HADS and IES-R. Logistic regression models were applied to examine associations between screening results and outcomes. RESULTS This study included 297 OHCA survivors. During hospitalisation, 65% presented with cognitive impairment, 25% reported symptoms of anxiety, 20% symptoms of depression and 21% symptoms of traumatic distress. At follow-up, 53% reported cognitive impairment, 17% symptoms of anxiety, 15% symptoms of depression and 19% symptoms of traumatic distress. Cognitive impairment during hospitalisation was associated with higher odds (OR (95% CI) 2.55 (1.36-4.75), p = .02) of an unfavorable cognitive outcome at follow-up, and symptoms of psychopathology during hospitalisation were associated with higher odds of psychopathology at follow-up across all three symptom groups; anxiety (6.70 (2.40-18.72), p < .001), depression (4.69 (1.69-13.02), p < .001) and traumatic distress (7.07 (2.67-18.73), p < .001). CONCLUSION OHCA survivors exhibited both cognitive impairment and symptoms of psychopathology during hospitalisation comparable to previous studies, which were associated with unfavorable mental health outcomes at three-month follow-up.
Collapse
Affiliation(s)
- Mette Kirstine Wagner
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark.
| | - Selina Kikkenborg Berg
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen N, Denmark
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen E, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen N, Denmark
| | - Britt Borregaard
- Department of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark; Department of Cardiology, Odense University Hospital, J.B. Winsloews Vej 4, 5000 Odense, Denmark
| | - Trine Bernholdt Rasmussen
- Department of Cardiology, Herlev and Gentofte University Hospital, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Ola Ekholm
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455 Copenhagen K, Denmark
| | - Dea Siggaard Stenbæk
- Neurobiology Research Unit, Copenhagen University Hospital, Rigshospitalet, Inge Lehmanns Vej 6, 2100 Copenhagen E, Denmark; Institute of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Denmark
| |
Collapse
|
9
|
Kim JS, Kim YJ, Ryoo SM, Ahn S, Kim WY. Telephone-based evaluation of cognitive impairment and mood disorders in cardiac arrest survivors with good neurologic outcomes: a retrospective cohort study. Sci Rep 2023; 13:18065. [PMID: 37872205 PMCID: PMC10593735 DOI: 10.1038/s41598-023-44963-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 10/13/2023] [Indexed: 10/25/2023] Open
Abstract
This study determined the occurrence of cognitive impairment and mood disorders in out-of-hospital cardiac arrest (OHCA) survivors with good neurologic outcomes. We performed a retrospective, cross-sectional, single-center study with a total of 97 patients. We evaluated cognitive dysfunction via the Montreal Cognitive Assessment and Alzheimer's disease-8 mood disorders via the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale. We measured quality of life with the European Quality of Life 5-Dimension 5-Levels questionnaire. Cognitive impairment and mood disorders were common among patients with good neurologic recovery. There were 23 patients who experienced cognitive impairments (23.7%) and 28 who suffered from mood disorders (28.9%). Age (adjusted OR 1.07, 95% CI 1.02-1.12), mood disorders (adjusted OR 22.80, 95% CI 4.84-107.49) and hospital length of stay (adjusted OR 1.05, 95% CI 1.02-1.09) were independent risk factors for cognitive impairment. The occurrence of cognitive impairments (adjusted OR 9.94, 95% CI 2.83-35.97) and non-cardiac causes of cardiac arrest (adjusted OR 11.51, 95% CI 3.15-42.15) were risk factors for mood disorders. Quality of life was significantly lower in the OHCA survivors with each disorder than the healthy individuals. Routine screening and intervention are needed for OHCA survivors.
Collapse
Affiliation(s)
- June-Sung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Youn-Jung Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Seung Mok Ryoo
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Shin Ahn
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea
| | - Won Young Kim
- Department of Emergency Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
| |
Collapse
|
10
|
Lilja G, Ullén S, Dankiewicz J, Friberg H, Levin H, Nordström EB, Heimburg K, Jakobsen JC, Ahlqvist M, Bass F, Belohlavek J, Olsen RB, Cariou A, Eastwood G, Fanebust HR, Grejs AM, Grimmer L, Hammond NE, Hovdenes J, Hrecko J, Iten M, Johansen H, Keeble TR, Kirkegaard H, Lascarrou JB, Leithner C, Lesona ME, Levis A, Mion M, Moseby-Knappe M, Navarra L, Nordberg P, Pelosi P, Quayle R, Rylander C, Sandberg H, Saxena M, Schrag C, Siranec M, Tiziano C, Vignon P, Wendel-Garcia PD, Wise MP, Wright K, Nielsen N, Cronberg T. Effects of Hypothermia vs Normothermia on Societal Participation and Cognitive Function at 6 Months in Survivors After Out-of-Hospital Cardiac Arrest: A Predefined Analysis of the TTM2 Randomized Clinical Trial. JAMA Neurol 2023; 80:1070-1079. [PMID: 37548968 PMCID: PMC10407762 DOI: 10.1001/jamaneurol.2023.2536] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 05/25/2023] [Indexed: 08/08/2023]
Abstract
Importance The Targeted Hypothermia vs Targeted Normothermia After Out-of-Hospital Cardiac Arrest (TTM2) trial reported no difference in mortality or poor functional outcome at 6 months after out-of-hospital cardiac arrest (OHCA). This predefined exploratory analysis provides more detailed estimation of brain dysfunction for the comparison of the 2 intervention regimens. Objectives To investigate the effects of targeted hypothermia vs targeted normothermia on functional outcome with focus on societal participation and cognitive function in survivors 6 months after OHCA. Design, Setting, and Participants This study is a predefined analysis of an international multicenter, randomized clinical trial that took place from November 2017 to January 2020 and included participants at 61 hospitals in 14 countries. A structured follow-up for survivors performed at 6 months was by masked outcome assessors. The last follow-up took place in October 2020. Participants included 1861 adult (older than 18 years) patients with OHCA who were comatose at hospital admission. At 6 months, 939 of 1861 were alive and invited to a follow-up, of which 103 of 939 declined or were missing. Interventions Randomization 1:1 to temperature control with targeted hypothermia at 33 °C or targeted normothermia and early treatment of fever (37.8 °C or higher). Main outcomes and measures Functional outcome focusing on societal participation assessed by the Glasgow Outcome Scale Extended ([GOSE] 1 to 8) and cognitive function assessed by the Montreal Cognitive Assessment ([MoCA] 0 to 30) and the Symbol Digit Modalities Test ([SDMT] z scores). Higher scores represent better outcomes. Results At 6 months, 836 of 939 survivors with a mean age of 60 (SD, 13) (range, 18 to 88) years (700 of 836 male [84%]) participated in the follow-up. There were no differences between the 2 intervention groups in functional outcome focusing on societal participation (GOSE score, odds ratio, 0.91; 95% CI, 0.71-1.17; P = .46) or in cognitive function by MoCA (mean difference, 0.36; 95% CI,-0.33 to 1.05; P = .37) and SDMT (mean difference, 0.06; 95% CI,-0.16 to 0.27; P = .62). Limitations in societal participation (GOSE score less than 7) were common regardless of intervention (hypothermia, 178 of 415 [43%]; normothermia, 168 of 419 [40%]). Cognitive impairment was identified in 353 of 599 survivors (59%). Conclusions In this predefined analysis of comatose patients after OHCA, hypothermia did not lead to better functional outcome assessed with a focus on societal participation and cognitive function than management with normothermia. At 6 months, many survivors had not regained their pre-arrest activities and roles, and mild cognitive dysfunction was common. Trial Registration ClinicalTrials.gov Identifier: NCT02908308.
Collapse
Affiliation(s)
- Gisela Lilja
- Clinical Studies Sweden, Forum South, Skane University Hospital, Lund, Sweden
| | - Susann Ullén
- Clinical Studies Sweden, Forum South, Skane University Hospital, Lund, Sweden
| | - Josef Dankiewicz
- Cardiology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Hans Friberg
- Anesthesia and Intensive Care, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Malmö, Sweden
| | - Helena Levin
- Anesthesia and Intensive Care, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Malmö, Sweden
| | - Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Katarina Heimburg
- Neurology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Center for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Marita Ahlqvist
- Department of Anaesthesiology and Intensive Care Medicine, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frances Bass
- Critical Care Program, The George Institute for Global Health and UNSW Sydney, Sydney, New South Wales, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jan Belohlavek
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | | | - Alain Cariou
- Cochin University Hospital (APHP) and Paris Cité University (medical school), Paris, France
| | - Glenn Eastwood
- Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia
| | - Hans Rune Fanebust
- Cardiac Intensive Care Unit, Haukeland University Hospital, Bergen, Norway
| | - Anders M. Grejs
- Department of Intensive Care Medicine and Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lisa Grimmer
- University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Naomi E. Hammond
- Critical Care Program, The George Institute for Global Health and UNSW Sydney, Sydney, New South Wales, Australia
- Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Jan Hovdenes
- Department of Anesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Juraj Hrecko
- The 1st Department of Internal Medicine, Cardioangiology, Medical Faculty of Charles University in Hradec Králové and University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Manuela Iten
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Henriette Johansen
- Department of Neurology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Thomas R. Keeble
- Essex Cardio Thoracic Centre, Basildon, Essex, UK Thurrock University Hospitals, Basildon, United Kingdom
- MTRC, Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford, Essex, United Kingdom
| | - Hans Kirkegaard
- Research Center for Emergency Medicine, Emergency Department Aarhus University Hospital and Department of Clinical Medicine Aarhus University, Aarhus, Denmark
| | | | - Christoph Leithner
- Charité- Universitätsmedizin Berlin, coroporate member of Freie Universität Berlin and Humboldt- Universität-zu-Berlin, Department of Neurology, Berlin, Germany
| | | | - Anja Levis
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Anesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marco Mion
- Essex Cardio Thoracic Centre, Basildon, Essex, UK Thurrock University Hospitals, Basildon, United Kingdom
- MTRC, Anglia Ruskin University Faculty of Health Education Medicine & Social Care, Chelmsford, Essex, United Kingdom
| | - Marion Moseby-Knappe
- Neurology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| | - Leanlove Navarra
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Per Nordberg
- Center for Resuscitation Sciences, Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Paolo Pelosi
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
- Anesthesia and Critical Care, San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences, Genoa, Italy
| | - Rachael Quayle
- Manchester Foundation Trust, Manchester, United Kingdom
- The Greater Manchester NIHR Clinical Research Network, Manchester, United Kingdom
| | - Christian Rylander
- Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Sweden
| | | | - Manoj Saxena
- St George Hospital Clinical School, The George institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Claudia Schrag
- Intensive Care Department, Kantonspital St Gallen, St Gallen, Switzerland
| | - Michal Siranec
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Cassina Tiziano
- Cardiac anesthesia and Intensive Care department, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Philippe Vignon
- Medical-surgical ICU and Inserm CIC 1435, Dupuytren University hospital, Limoges, France
| | | | - Matt P. Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom
| | - Kim Wright
- University Hospitals Bristol and Weston NHS Trust, Bristol, United Kingdom
| | - Niklas Nielsen
- Department of Clinical Sciences Lund, Anaesthesia and Intensive Care and Clinical Sciences Helsingborg, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden
| |
Collapse
|
11
|
Aregger Lundh S, Israelsson J, Hagell P, Lilja Andersson P, Årestedt K. Life satisfaction in cardiac arrest survivors: A nationwide Swedish registry study. Resusc Plus 2023; 15:100451. [PMID: 37662640 PMCID: PMC10470084 DOI: 10.1016/j.resplu.2023.100451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Most cardiac arrest (CA) survivors report good health and quality of life. Life satisfaction on the other hand has not yet been studied in a large scale in the CA population. We aimed to explore life satisfaction as perceived by CA survivors with three research questions addressed: (1) how do CA survivors report their life satisfaction, (2) how are different domains of life satisfaction associated with overall life satisfaction, and (3) how are demographic and medical factors associated with overall life satisfaction? Methods This registry study had a cross-sectional design. Life satisfaction was assessed using the 11-item Life Satisfaction checklist (LiSat-11). The sample included 1435 survivors ≥18 years of age. Descriptive statistics and binary logistic regression analyses were used. Results Survivors were most satisfied with partner relation (85.6%), family life (82.2%), and self-care (77.8%), while 60.5% were satisfied with overall life. Satisfaction with psychological health was strongest associated with overall life satisfaction. Among medical and demographic factors, female sex and poor cerebral performance were associated with less overall life satisfaction. Conclusions Generally, CA survivors seem to perceive similar levels of overall life satisfaction as general populations, while survivors tend to be significantly less satisfied with their sexual life. Satisfaction with psychological health is of special interest to identify and treat. Additionally, female survivors and survivors with poor neurological outcome are at risk for poorer overall life satisfaction and need special attention by healthcare professionals.
Collapse
Affiliation(s)
- Stefan Aregger Lundh
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Johan Israelsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Internal Medicine, Division of Cardiology, Region Kalmar County, Kalmar, Sweden
| | - Peter Hagell
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Petra Lilja Andersson
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| |
Collapse
|
12
|
Hellström P, Israelsson J, Hellström A, Hjelm C, Broström A, Årestedt K. Is insomnia associated with self-reported health and life satisfaction in cardiac arrest survivors? A cross-sectional survey. Resusc Plus 2023; 15:100455. [PMID: 37662641 PMCID: PMC10474489 DOI: 10.1016/j.resplu.2023.100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 07/19/2023] [Accepted: 08/05/2023] [Indexed: 09/05/2023] Open
Abstract
Background Insomnia symptoms seem to be common in cardiac arrest survivors but their associations with important outcomes such as self-reported health and life satisfaction have not previously been reported during the early post-event period. Therefore, the aim of the study was to investigate whether symptoms of insomnia are associated with self-reported health and life satisfaction in cardiac arrest survivors six months after the event. Methods This multicentre cross-sectional survey included cardiac arrest survivors ≥18 years. Participants were recruited six months after the event from five hospitals in southern Sweden, and completed a questionnaire including the Minimal Insomnia Symptom Scale, EQ-5D-5L, Health Index, Hospital Anxiety and Depression Scale, and Satisfaction With Life Scale. Data were analysed using the Mann-Whitney U test, linear regression, and ordinal logistic regression. The regression analyses were adjusted for demographic and medical factors. Results In total, 212 survivors, 76.4% males, with a mean age of 66.6 years (SD = 11.9) were included, and of those, 20% reported clinical insomnia. Insomnia was significantly associated with all aspects of self-reported health (p < 0.01) and life satisfaction (p < 0.001), except mobility (p = 0.093), self-care (p = 0.676), and usual activities (p = 0.073). Conclusion Insomnia plays a potentially important role for both health and life satisfaction in cardiac arrest survivors. Screening for sleep problems should be part of post cardiac arrest care and follow-up to identify those in need of further medical examination and treatment.
Collapse
Affiliation(s)
- Patrik Hellström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Johan Israelsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Region Kalmar County, Kalmar, Sweden
| | - Amanda Hellström
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Carina Hjelm
- Department of Health, Medicine and Care, Nursing and Reproductive Health, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Clinical Neurophysiology, Linköping University Hospital, Linköping, Sweden
- Department of Nursing Science, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- The Research Section, Region Kalmar County, Kalmar, Sweden
| |
Collapse
|
13
|
Blennow Nordström E, Vestberg S, Evald L, Mion M, Segerström M, Ullén S, Bro-Jeppesen J, Friberg H, Heimburg K, Grejs AM, Keeble TR, Kirkegaard H, Ljung H, Rose S, Wise MP, Rylander C, Undén J, Nielsen N, Cronberg T, Lilja G. 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. Crit Care 2023; 27:328. [PMID: 37633944 PMCID: PMC10463667 DOI: 10.1186/s13054-023-04617-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 08/16/2023] [Indexed: 08/28/2023] Open
Abstract
BACKGROUND Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA. METHODS This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. RESULTS Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance. CONCLUSIONS In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue. TRIAL REGISTRATION ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
Collapse
Affiliation(s)
- Erik Blennow Nordström
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
| | | | - Lars Evald
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Marco Mion
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Magnus Segerström
- Department of Neurology and Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susann Ullén
- Clinical Studies Sweden - Forum South, Skane University Hospital, Lund, Sweden
| | - John Bro-Jeppesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Friberg
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
| | - Katarina Heimburg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Anders M Grejs
- Department of Intensive Care Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Thomas R Keeble
- Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, UK
- Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, UK
| | - Hans Kirkegaard
- Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Hanna Ljung
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Sofia Rose
- Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, UK
| | - Matthew P Wise
- Adult Critical Care, University Hospital of Wales, Cardiff, UK
| | - Christian Rylander
- Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Johan Undén
- Intensive and Perioperative Care, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Malmö, Sweden
- Operation and Intensive Care, Hallands Hospital Halmstad, Halmstad, Sweden
| | - Niklas Nielsen
- Anesthesiology and Intensive Care, Department of Clinical Sciences Lund, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Tobias Cronberg
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| | - Gisela Lilja
- Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden
| |
Collapse
|
14
|
Gagnon C, Bherer L. The Role of Neuropsychology in Adult Cardiology. Can J Cardiol 2023; 39:225-228. [PMID: 36370983 DOI: 10.1016/j.cjca.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/03/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Christine Gagnon
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada
| | - Louis Bherer
- Research Center and Centre ÉPIC, Montreal Heart Institute, Montréal, Québec, Canada; Department of Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Research Center, Institut Universitaire de Gériatrie de Montréal, Montréal, Québec, Canada.
| |
Collapse
|
15
|
The aftermath of surviving a sudden cardiac arrest for young exercisers - a qualitative study in Norway. BMC Health Serv Res 2022; 22:1452. [PMID: 36451196 PMCID: PMC9709361 DOI: 10.1186/s12913-022-08674-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/11/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional effects of surviving may be present for months or years. The survivors' family and colleagues are also highly affected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. METHODS The study had a qualitative design, conducting in-depth individual interviews with SCA survivors < 50 years of age reporting to exercise ≥ 5 h/week and/or who suffered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. RESULTS 18 of 31 eligible participants were included in the study. Through analysis we identified 'Establishing a new everyday life' as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! CONCLUSION This study adds knowledge about young and regular exercisers' experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have persistent challenges that cause frustration and reduced quality of life.
Collapse
|
16
|
Screening for neurocognitive impairment following out-of-hospital cardiac arrest: anyone for a MoCA? Resuscitation 2022; 172:137-138. [DOI: 10.1016/j.resuscitation.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/23/2022]
|
17
|
van Gils P, van Heugten C, Hofmeijer J, Keijzer H, Nutma S, Duits A. The Montreal Cognitive Assessment is a valid Cognitive Screening Tool for Cardiac Arrest Survivors. Resuscitation 2021; 172:130-136. [PMID: 34958880 DOI: 10.1016/j.resuscitation.2021.12.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/25/2023]
Abstract
AIM The survival rate of out-of-hospital cardiac arrest (OHCA) patients has increased over the past decades. This gives rise to a growing number of patients with hypoxic-ischemic brain damage and cognitive impairment. Currently, cognitive impairment is underdiagnosed in OHCA patients. There is a need for a validated cognitive screening instrument to identify patients with cognitive impairment. This study aimed to examine the diagnostic value of the Montreal Cognitive Assessment (MoCA) in patients after OHCA. METHODS Survivors (age ≥18 years) of OHCA completed the MoCA and a gold standard neuropsychological test battery, including tests for memory, attention, perception, language, reasoning, and executive functioning, at around one year after OHCA. Results of the MoCA are related to the results of the neuropsychological test battery. Analyses of diagnostic accuracy included receiver operating characteristics and calculation of predictive values. RESULTS We included 54 OHCA survivors (mean age = 57.3, 74% male). The area under the curve (AUC) was 0.8, 95% CI [0.67, 0.93]. The MoCA showed excellent sensitivity of 86%, 95% CI [57, 98] and adequate specificity of 70.0%, 95% CI [53, 83] to detect cognitive impairment at the regular cut-off score of 26. The positive predictive value of the MoCA was 50%, 95% CI [30, 70] and the negative predictive value was 93%, 95% CI [76, 99]. CONCLUSION This study shows that the MoCA may be a valid cognitive screening instrument for use in the OHCA patient population.
Collapse
Affiliation(s)
- Pauline van Gils
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands
| | - Caroline van Heugten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Neuropsychology and psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands.
| | - Jeannette Hofmeijer
- Clinical Neurophysiology (CNPH), TechMed Centre, University of Twente, Enschede, the Netherlands; Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands
| | - Hanneke Keijzer
- Department of Neurology, Rijnstate Hospital, Arnhem, the Netherlands; Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sjoukje Nutma
- Department of Neurology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Annelien Duits
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Limburg Brain Injury Center, Maastricht University, Maastricht, the Netherlands; Department of Medical Psychology, Maastricht University Medical Center, Maastricht, the Netherlands
| |
Collapse
|
18
|
Haywood KL, Dainty KN, Swartz R. The what, when, how and who of neurocognitive function: The importance of assessment quality and community engagement. Resuscitation 2021; 170:247-249. [PMID: 34838663 DOI: 10.1016/j.resuscitation.2021.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
| | - Katie N Dainty
- Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rick Swartz
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON, Canada
| |
Collapse
|