Cognitive dysfunction after out-of-hospital cardiac arrest: Rate of impairment and clinical predictors

Aziza Byron-Alhassan; Barbara Collins; Marc Bedard; Bonnie Quinlan; Michel Le May; Lloyd Duchesne; Christina Osborne; George Wells; Andra M Smith; Heather E Tulloch

doi:10.1016/j.resuscitation.2021.05.002

Cognitive dysfunction after out-of-hospital cardiac arrest: Rate of impairment and clinical predictors

Resuscitation. 2021 Aug:165:154-160. doi: 10.1016/j.resuscitation.2021.05.002. Epub 2021 May 12.

Authors

Affiliations

¹ Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada; School of Psychology, University of Ottawa, Ottawa, Canada.
² Clinical Services, University of Ottawa Heart Institute, Ottawa, Canada.
³ Cardiology, University of Ottawa Heart Institute, Ottawa, Canada.
⁴ Clinical Research, University of Ottawa Heart Institute, Ottawa, Canada.
⁵ Cardiovascular Research Methods Centre, University of Ottawa Heart Institute, Ottawa, Canada.
⁶ School of Psychology, University of Ottawa, Ottawa, Canada.
⁷ Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada; School of Psychology, University of Ottawa, Ottawa, Canada. Electronic address: hetulloch@ottawaheart.ca.

PMID: 33991604
DOI: 10.1016/j.resuscitation.2021.05.002

Abstract

Background: The purpose of this study was to evaluate the rate and domains of cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, as compared to patients who experienced a myocardial infarction (MI), and to explore mechanisms and predictors of this impairment.

Methods and results: OHCA survivors with "good" neurological recovery (i.e., Cerebral Performance Categories Scale ≤ 2) (n = 79), as well as a control group of MI patients (n = 69), underwent a comprehensive neuropsychological assessment. Forty-three percent of OHCA survivors were cognitively impaired (in the lowest decile on a global measure of cognitive functioning). Rates of impairment were approximately six times higher in the OHCA group than the MI group. Attention, memory, language and executive function were affected. Downtime was a significant predictor of cognitive impairment; the interaction between downtime and immediate intervention was significant such that, at short downtimes, receiving cardiopulmonary resuscitation (CPR) or defibrillation within 1 min of collapse predicted less cognitive impairment.

Conclusions: OHCA survivors - even those with seemingly good neurological recovery - are at risk for cognitive impairment. Cognitive rehabilitation may be an important consideration post-OHCA.

Keywords: Cognition; Myocardial infarction; Out-of-hospital cardiac arrest; Outcomes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiopulmonary Resuscitation*
Cognitive Dysfunction* / epidemiology
Cognitive Dysfunction* / etiology
Humans
Neuropsychological Tests
Out-of-Hospital Cardiac Arrest* / complications
Out-of-Hospital Cardiac Arrest* / therapy
Time Factors