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Cognitive function after cardiac arest and targeted temperature management

Lilja, Gisela LU (2015) In Lund University Faculty of Medicine Doctoral Dissertation Series 2015:126.
Abstract
This thesis focuses on cognitive impairment in Out-of-Hospital Cardiac Arrest (OHCA) survivors with the main aim

to evaluate possible effects by targeted temperature management. Secondary aims are to describe the prevalence of

cognitive impairment in a large group of OHCA-survivors, the related symptoms of psychological distress and the

actual effect of cognitive impairment for the patient’s ability to participate in everyday life and in the society (as

work).

Methods: In an international trial, OHCA-patients, unconscious after resuscitation, were randomized to 33°C or

36°C controlled temperature. Survivors were invited to a face-to-face follow-up 180 days post-arrest that... (More)
This thesis focuses on cognitive impairment in Out-of-Hospital Cardiac Arrest (OHCA) survivors with the main aim

to evaluate possible effects by targeted temperature management. Secondary aims are to describe the prevalence of

cognitive impairment in a large group of OHCA-survivors, the related symptoms of psychological distress and the

actual effect of cognitive impairment for the patient’s ability to participate in everyday life and in the society (as

work).

Methods: In an international trial, OHCA-patients, unconscious after resuscitation, were randomized to 33°C or

36°C controlled temperature. Survivors were invited to a face-to-face follow-up 180 days post-arrest that included

screening of cognitive impairment (MiniMental Status Examination), questionnaires of cognitive performance in

everyday life (Two Simple Questions, Informant Questionnaire on Cognitive Decline) and Health Related Quality

of Life (HRQoL) (Short Form Questionniare-36 version2®). An extended follow-up was performed at 20 sites in

five countries and included assessments of memory (Rivermead Behavioural Memory Test), executive functions

(Frontal Assessment Battery), attention/processing speed (Symbol Digit Modalities Test), psychological distress

(Hospital Anxiety and Depression Scale) and participation (Mayo-Portland Adaptability Inventory-4). A matched

control group of ST-elevation myocardial infarction (STEMI) patients performed the same follow-up.

Results: OHCA-survivors (n=287) had overall good outcome and HRQoL, but half reported a decreased

participation in everyday life and society. In addition, many informants (62%) and patients (36%) reported cognitive

problems, and 27% of survivors reported psychological distress. By objective assessments cognitive impairment

was found in >50% of the survivors, and OHCA-survivors with cognitive impairment had an increased risk of being

on sick leave. Cognitive impairment, depression, fatigue, and mobility restrictions were found important for

participation in everyday life and in the society There were no differences in any of these outcomes between the two

temperature groups (33°C and 36°C). Cognitive impairment and psychological distress was common also among

STEMI-controls (n=119), but OHCA-survivors had significantly more problems with attention/processing speed,

return to work and participation compared to STEMI-controls.

Conclusion. The two groups of TTM at 33°C and 36°C were similar also when brain injury is assessed in detail

indicating no difference in outcome. Cognitive impairment was common in OHCA-survivors but STEMI-controls

shared many of the symptoms and that impairment after OHCA needs to be seen in a greater context of risk factors

including OHCA-related brain injury, cardiovascular co-morbidity, and critical illness related stressors. OHCAsurvivors

had lower participation in everyday life compared to STEMI-controls. A structured follow-up to identify

OHCA-survivors in risk for long-term consequences is recommended. Cognitive impairment, fatigue, mobility

restrictions and depression deserve increased attention during such follow-up. (Less)
Please use this url to cite or link to this publication:
author
supervisor
opponent
  • Professor Soreide, Eldar, University of Bergen and Univerity of Stavanger
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Out-of-hospital cardiac arrest, cognition, neurological outcome, Quality of Life, Social participation
in
Lund University Faculty of Medicine Doctoral Dissertation Series
volume
2015:126
pages
84 pages
publisher
Neurology, Lund
defense location
Segerfalksalen, BMC A10, Sölvegatan 17, Lund
defense date
2015-11-28 09:30
ISSN
1652-8220
ISBN
978-91-7619-206-1
language
English
LU publication?
yes
id
437e7486-b71a-455e-b0b6-41d465706416 (old id 8167167)
date added to LUP
2015-11-10 14:16:01
date last changed
2016-09-19 08:44:49
@phdthesis{437e7486-b71a-455e-b0b6-41d465706416,
  abstract     = {This thesis focuses on cognitive impairment in Out-of-Hospital Cardiac Arrest (OHCA) survivors with the main aim<br/><br>
to evaluate possible effects by targeted temperature management. Secondary aims are to describe the prevalence of<br/><br>
cognitive impairment in a large group of OHCA-survivors, the related symptoms of psychological distress and the<br/><br>
actual effect of cognitive impairment for the patient’s ability to participate in everyday life and in the society (as<br/><br>
work).<br/><br>
Methods: In an international trial, OHCA-patients, unconscious after resuscitation, were randomized to 33°C or<br/><br>
36°C controlled temperature. Survivors were invited to a face-to-face follow-up 180 days post-arrest that included<br/><br>
screening of cognitive impairment (MiniMental Status Examination), questionnaires of cognitive performance in<br/><br>
everyday life (Two Simple Questions, Informant Questionnaire on Cognitive Decline) and Health Related Quality<br/><br>
of Life (HRQoL) (Short Form Questionniare-36 version2®). An extended follow-up was performed at 20 sites in<br/><br>
five countries and included assessments of memory (Rivermead Behavioural Memory Test), executive functions<br/><br>
(Frontal Assessment Battery), attention/processing speed (Symbol Digit Modalities Test), psychological distress<br/><br>
(Hospital Anxiety and Depression Scale) and participation (Mayo-Portland Adaptability Inventory-4). A matched<br/><br>
control group of ST-elevation myocardial infarction (STEMI) patients performed the same follow-up.<br/><br>
Results: OHCA-survivors (n=287) had overall good outcome and HRQoL, but half reported a decreased<br/><br>
participation in everyday life and society. In addition, many informants (62%) and patients (36%) reported cognitive<br/><br>
problems, and 27% of survivors reported psychological distress. By objective assessments cognitive impairment<br/><br>
was found in &gt;50% of the survivors, and OHCA-survivors with cognitive impairment had an increased risk of being<br/><br>
on sick leave. Cognitive impairment, depression, fatigue, and mobility restrictions were found important for<br/><br>
participation in everyday life and in the society There were no differences in any of these outcomes between the two<br/><br>
temperature groups (33°C and 36°C). Cognitive impairment and psychological distress was common also among<br/><br>
STEMI-controls (n=119), but OHCA-survivors had significantly more problems with attention/processing speed,<br/><br>
return to work and participation compared to STEMI-controls.<br/><br>
Conclusion. The two groups of TTM at 33°C and 36°C were similar also when brain injury is assessed in detail<br/><br>
indicating no difference in outcome. Cognitive impairment was common in OHCA-survivors but STEMI-controls<br/><br>
shared many of the symptoms and that impairment after OHCA needs to be seen in a greater context of risk factors<br/><br>
including OHCA-related brain injury, cardiovascular co-morbidity, and critical illness related stressors. OHCAsurvivors<br/><br>
had lower participation in everyday life compared to STEMI-controls. A structured follow-up to identify<br/><br>
OHCA-survivors in risk for long-term consequences is recommended. Cognitive impairment, fatigue, mobility<br/><br>
restrictions and depression deserve increased attention during such follow-up.},
  author       = {Lilja, Gisela},
  isbn         = {978-91-7619-206-1},
  issn         = {1652-8220},
  keyword      = {Out-of-hospital cardiac arrest,cognition,neurological outcome,Quality of Life,Social participation},
  language     = {eng},
  pages        = {84},
  publisher    = {Neurology, Lund},
  school       = {Lund University},
  series       = {Lund University Faculty of Medicine Doctoral Dissertation Series},
  title        = {Cognitive function after cardiac arest and targeted temperature management},
  volume       = {2015:126},
  year         = {2015},
}