Neurocognitive outcomes following successful resuscitation from cardiac arrest.
BACKGROUND
Cardiac arrest commonly results in varying degrees of cognitive injury. Standard outcome measures used in the cardiac arrest cohort do not rigorously evaluate for these injury patterns. We examined the utility of the Computerized Assessment for Mild Cognitive Injury (CAMCI) in cardiac arrest (CA) survivors. We hypothesized that cognitive deficits would be more severe in patients who were comatose on hospital arrival.


METHODS
Prospective cohort of CA survivors at a single tertiary care facility where participants received neurocognitive testing using CAMCI. CAMCI results were subdivided into memory, attention, and executive functions. Scores between subjects who were initially comatose and were not comatose following resuscitation were compared using the Mann-Whitney test.


RESULTS
Of 72 subjects included, the majority (N=44) were initially comatose following resuscitation with mean age of 54 (±14) years. The majority experienced a good neurologic outcome based on Cerebral Performance Category (N=47; 66%) and Modified Rankin Scale (N=38; 53%). Time from resuscitation to CAMCI testing was not associated with total CAMCI score in this cohort (Pearson's r(2) value -0.1941, p=0.20). Initially comatose and not comatose subjects did not differ in their CAMCI overall scores (p=0.33), or in any subtest areas. The not comatose cohort had 1 subtest for which there was a Moderate Risk for mild cognitive impairment (Nonverbal Accuracy), and 2 for which there was a Moderately Low Risk (Verbal Accuracy and Executive Accuracy). The Comatose cohort had 4 subtests, which were deemed Moderately Low Risk for cognitive impairment (Verbal Accuracy, Attention Accuracy, Executive Accuracy and Nonverbal Accuracy).


CONCLUSIONS
In-hospital CAMCI testing suggests memory, attention and executive impairment are commonly in patients following resuscitation from cardiac arrest. Outcome evaluations should test for deficits in memory, attention, and executive function.
School of Medicine, University of Pittsburgh, United States.
Alexa R
AR
Sabedra
Department of Emergency Medicine, University of Pittsburgh, United States.
Jeffrey
J
Kristan
Department of Occupational Therapy, University of Pittsburgh, United States.
Ketki
K
Raina
Department of Occupational Therapy, University of Pittsburgh, United States.
Margo B
MB
Holm
Department of Emergency Medicine, University of Pittsburgh, United States.
Clifton W
CW
Callaway
Department of Emergency Medicine, University of Pittsburgh, United States.
Francis X
FX
Guyette
Department of Critical Care Medicine, University of Pittsburgh, United States.
Cameron
C
Dezfulian
Department of Emergency Medicine, University of Pittsburgh, United States.
Ankur A
AA
Doshi
Department of Emergency Medicine, University of Pittsburgh, United States. Electronic address: rittjc@upmc.edu.
Jon C
JC
Rittenberger
D016887:Cardiopulmonary Resuscitation; D003071:Cognition; D003128:Coma / Q000209:etiology / Q000628:therapy; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D011446:Prospective Studies; D017741:Survivors
Cognition; Critical care; Heart arrest; Hypothermia; Patient outcome assessment; Resuscitation