Long-term subjective memory function in ventricular fibrillation out-of-hospital cardiac arrest survivors resuscitated by early defibrillation.
BACKGROUND
Brain injury after a cardiac arrest remains a major cause of morbidity. Programs focusing on early defibrillation have yielded improved survival of patients after hospital discharge following ventricular fibrillation (VF) out-of-hospital cardiac arrest (OHCA). Early defibrillation that promptly restores a circulating rhythm should decrease the hypoxic period and subsequent organ injury. Therefore this study was designed to determine if long-term memory complaints persist in VF OHCA survivors resuscitated in an early defibrillation program when compared with a healthy control population not experiencing cardiac arrest.


METHODS
All patients with an OHCA between November 1990 and January 2001 who received defibrillation by emergency medical services personnel in Olmsted County, MN, USA, were included. The memory function questionnaire (MFQ), a 64-item, 7-point Likert-scaled instrument to evaluate the perception of everyday memory functioning was sent to all survivors. The MFQ comprises four scales: general frequency of forgetting (rates general forgetting), retrospective functioning (compares current memory with past ability), seriousness of forgetting (rates how memory impairment impacts daily life), and mnemonics usage (measures adaptation). The MFQ is scaled so that high scores reflect less severe memory complaints. The comparison population comprised members of the Mayo Older Americans Normative Studies (MOANS) cohort. Quality of life was ascertained with a short form (SF)-36 survey.


RESULTS
Seventy-nine of the 200 VF OHCA patients (40%) were discharged. Twenty-two patients have died since dismissal, with an overall average length of follow-up of 4.9+/-3.0 years. Thirty-eight (67%) of the survivors completed the MFQ. Compared with the normal, there was a significant decrease in the general frequency of forgetting score of 144.2+/-37.4 versus 168.1+/-27.3 ( P<0.001) and the seriousness of forgetting score of 84.8 +/-26.7 versus 95.2+/-19.7 (P=0.004). The retrospective function-scale scores were not significantly different ( 18.4+/-6.8 versus 18.7+/- 5.0 (P=0.74). Younger patients (lesser than 65 years of age) reported an increase in general forgetting and the seriousness of forgetting compared with older survivors. A comparison with SF-36 scores suggested an association between general forgetting and decreased vitality (P=0.03) and the seriousness of forgetting with a decreased general health (P=0.005), mental health (P=0.009), physical functioning ( P=0.02 ), and vitality ( P=0.05).


CONCLUSIONS
In a cohort of VF OHCA patients, survivors report more memory complaints in comparison with a general healthy older population. There were more long-term-memory complaints in younger patients. Patients with higher long-term quality-of-life score have fewer memory complaints.
Bunch
T Jared
TJ
Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA.
White
Roger D
RD
Smith
Glenn E
GE
Hodge
David O
DO
Gersh
Bernard J
BJ
Hammill
Stephen C
SC
Shen
Win-Kuang
WK
Packer
Douglas L
DL
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D016022:Case-Control Studies; D003072:Cognition Disorders / Q000453:epidemiology / Q000209:etiology; D004554:Electric Countershock; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008569:Memory Disorders / Q000453:epidemiology* / Q000209:etiology; D011939:Mental Recall / Q000502:physiology*; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D017741:Survivors; D013997:Time Factors; D014693:Ventricular Fibrillation / Q000175:diagnosis / Q000628:therapy*