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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

Blennow Nordström, Erik LU orcid ; Vestberg, Susanna LU ; Evald, Lars ; Mion, Marco ; Segerström, Magnus ; Ullén, Susann LU ; Bro-Jeppesen, John ; Friberg, Hans LU ; Heimburg, Katarina LU and Grejs, Anders M. , et al. (2023) In Critical Care 27. p.1-13
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.... (More)

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.

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type
Contribution to journal
publication status
published
subject
keywords
Cardiovascular disease, Cognitive impairment, Heart arrest, Hypoxic-ischemic encephalopathy, Myocardial infarction, Outcome
in
Critical Care
volume
27
article number
328
pages
1 - 13
publisher
BioMed Central (BMC)
external identifiers
  • pmid:37633944
  • scopus:85168740704
ISSN
1364-8535
DOI
10.1186/s13054-023-04617-0
language
English
LU publication?
yes
additional info
Funding Information: We would like to thank Occupational Therapist and Associate Professor Lisa Gregersen Østergaard (Aarhus University Hospital and Aarhus University, Aarhus, Denmark) and Clinical Nurse Specialist Helen Hill for additional participant recruitment and project administration (University Hospital of Wales, Cardiff, UK), Registered Nurse and Swedeheart Registry Monitor Ewa Mattsson for project administration (Skane University Hospital, Lund, Sweden), former Psychology Assistant JuliaAgnes Svensson and Neuropsychologist Anna Karin Thulin for conducting some of the neuropsychological examinations (Skane University Hospital, Lund, Sweden). Funding Information: Open access funding provided by Lund University. This study was supported by The Skane University Hospital Foundations, The Skane University Hospital Psychology Research and Development Grant, The Hans-Gabriel and Alice Trolle-Wachtmeister Foundation for Medical Research, The Swedish Neuropsychological Society Research Grant, and The Royal Physiographic Society of Lund. The funding bodies had no role in the design of the study, data collection, analysis, or interpretation of data or in writing the manuscript. Publisher Copyright: © 2023, BioMed Central Ltd., part of Springer Nature.
id
266d7df2-4d1e-4c53-af94-39d7b4390388
date added to LUP
2023-09-05 08:57:39
date last changed
2024-04-20 02:31:47
@article{266d7df2-4d1e-4c53-af94-39d7b4390388,
  abstract     = {{<p>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.</p>}},
  author       = {{Blennow Nordström, Erik and Vestberg, Susanna and Evald, Lars and Mion, Marco and Segerström, Magnus and Ullén, Susann and Bro-Jeppesen, John and Friberg, Hans and Heimburg, Katarina and Grejs, Anders M. and Keeble, Thomas R. and Kirkegaard, Hans and Ljung, Hanna and Rose, Sofia and Wise, Matthew P. and Rylander, Christian and Undén, Johan and Nielsen, Niklas and Cronberg, Tobias and Lilja, Gisela}},
  issn         = {{1364-8535}},
  keywords     = {{Cardiovascular disease; Cognitive impairment; Heart arrest; Hypoxic-ischemic encephalopathy; Myocardial infarction; Outcome}},
  language     = {{eng}},
  pages        = {{1--13}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Critical Care}},
  title        = {{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}},
  url          = {{http://dx.doi.org/10.1186/s13054-023-04617-0}},
  doi          = {{10.1186/s13054-023-04617-0}},
  volume       = {{27}},
  year         = {{2023}},
}