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1 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

Published online by Cambridge University Press:  21 December 2023

Erik Blennow Nordström*
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
Susanna Vestberg
Affiliation:
Lund University, Department of Psychology, Lund, Sweden.
Lars Evald
Affiliation:
Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark.
Marco Mion
Affiliation:
Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom. Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom.
Magnus Segerström
Affiliation:
Sahlgrenska University Hospital, Department of Neurology and Department of Cardiology, Gothenburg, Sweden.
Susann Ullen
Affiliation:
Skane University Hospital, Clinical Studies Sweden - Forum South, Lund, Sweden.
John Bro-Jeppesen
Affiliation:
Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark.
Hans Friberg
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Malmö, Sweden.
Katarina Heimburg
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
Anders M. Grejs
Affiliation:
Aarhus University Hospital and Aarhus University, Department of Intensive Care Medicine and Department of Clinical Medicine, Aarhus, Denmark.
Thomas R. Keeble
Affiliation:
Essex Cardiothoracic Centre, Mid and South Essex NHS Foundation Trust, Basildon, United Kingdom. Medical Technology Research Centre, Anglia Ruskin School of Medicine, Chelmsford, United Kingdom.
Hans Kirkegaard
Affiliation:
Aarhus University Hospital and Aarhus University, Research Centre for Emergency Medicine, Emergency Department and Department of Clinical Medicine, Aarhus, Denmark.
Hanna Ljung
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
Sofia Rose
Affiliation:
Clinical Psychology, Cardiff and Vale University Health Board, NHS Wales, Cardiff, United Kingdom.
Matthew P. Wise
Affiliation:
Adult Critical Care, University Hospital of Wales, Cardiff, United Kingdom.
Christian Rylander
Affiliation:
Department of Surgical Sciences, Anaesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
Johan Unden
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Intensive and Perioperative Care, Malmö, Sweden. Hallands Hospital Halmstad, Operation and Intensive Care, Halmstad, Sweden.
Niklas Nielsen
Affiliation:
Lund University, Helsingborg Hospital, Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund, Sweden
Tobias Cronberg
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
Gisela Lilja
Affiliation:
Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden.
*
Correspondence: Erik Blennow Nordström, Skane University Hospital, Department of Clinical Sciences Lund, Neurology, Lund, Sweden. erik.blennow_nordstrom@med.lu.se
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Abstract

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Objective:

To describe cognitive impairment in out-of-hospital cardiac arrest (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.

Participants and 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. We administered an extensive neuropsychological assessment at approximately 7 months post-cardiac event, including a neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes. Z-scores of individual tests were converted to neuropsychological composite scores per cognitive domain (verbal, visual/constructive, working memory, episodic memory, processing speed, executive functions). Between-group differences on the neuropsychological composite scores were investigated with linear regression. Associations between anxiety, depression, fatigue, insomnia, hypertension, diabetes, and the neuropsychological composite scores among OHCA survivors were calculated with Spearman’s rho.

Results:

Of 184 eligible OHCA survivors, 108 were included (mean age = 62, 88% male), with 92 MI controls enrolled (mean age = 64, 89% male). Amongst OHCA survivors, 29% performed z <-1 indicating at least borderline-mild impairment in >2 cognitive domains, and 14% performed z <-2 exhibiting major impairment in >1 cognitive domain. 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, processing speed (MD = -0.41 [-0.74, -0.09]) and executive functions (MD = -0.69 [-1.13, -0.24]) were also worse following OHCA. Depressive symptoms were associated with worse executive functions (rs = -0.37, p <0.001) and worse processing speed (rs = -0.27, p = 0.01) post-OHCA. Anxiety symptoms (rs = -0.21, p = 0.01) and general fatigue (rs = -0.24, p = 0.01) were associated with worse executive functions. Diabetes was associated with worse processing speed (rs = -0.20, p = 0.03), visual/constructive (rs = -0.29, p <0.001) and executive functions (rs = -0.25, p = 0.02), while hypertension and insomnia were not significantly associated with neuropsychological test performance.

Conclusions:

Cognitive impairment is generally mild following OHCA, but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. We suggest that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.

Type
Poster Session 08: Assessment | Psychometrics | Noncredible Presentations | Forensic
Copyright
Copyright © INS. Published by Cambridge University Press, 2023