Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Tiainen, Marjaana; Poutiainen, Erja; Kovala, Tero; Takkunen, O.; Häppölä, Olli; Roine, Risto O.

doi:10.1161/strokeaha.107.483867

Cited by 105 publications

(70 citation statements)

References 24 publications

(29 reference statements)

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“…Both of these landmark studies demonstrated improved outcomes, and the larger trial demonstrated a reduction in mortality, with TTM [8,9] . Evidence suggests TTM in this population is well tolerated, with no neurocognitive deficits associated with therapy [167] . With respect to patients with cardiogenic shock or requiring primary coronary angiography, TTM can be delivered safely, improving outcomes and not significantly increasing "doorto-balloon" times [9,168,169] .…”

Section: Indications For Ttmmentioning

confidence: 84%

Use of hypothermia in the intensive care unit

Corry¹

2012

WJCCM

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Used for over 3600 years, hypothermia, or targeted temperature management (TTM), remains an ill defined medical therapy. Currently, the strongest evidence for TTM in adults are for out-of-hospital ventricular tachycardia/ventricular fibrillation cardiac arrest, intracerebral pressure control, and normothermia in the neurocritical care population. Even in these disease processes, a number of questions exist. Data on disease specific therapeutic markers, therapeutic depth and duration, and prognostication are limited. Despite ample experimental data, clinical evidence for stroke, refractory status epilepticus, hepatic encephalopathy, and intensive care unit is only at the safety and proof-of-concept stage. This review explores the deleterious nature of fever, the theoretical role of TTM in the critically ill, and summarizes the clinical evidence for TTM in adults.

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Section: Indications For Ttmmentioning

confidence: 84%

Use of hypothermia in the intensive care unit

Corry¹

2012

WJCCM

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“…Several features of this study argue against residual confounding: (1) the biological approach used in developing the propensity score, which incorporated several baseline illness severity measures; (2) the finding of height, weight, and hospital as the only independent predictors of low VT in this cohort; and (3) similarities in intraarrest characteristics, APACHE-II, Day 1 SOFA, and shock incidence in the first 24 hours among patients receiving higher versus lower VT. Although CPC is a standard outcome in cardiac arrest studies (25), its sensitivity and discriminatory power for mild to moderate brain injury are controversial (56,57). Such may be limited further by relying on chart review alone to determine CPC.…”

Section: Original Articlementioning

confidence: 99%

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Beitler

Ghafouri

Jinadasa

et al. 2017

Am J Respir Crit Care Med

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Rationale: Neurocognitive outcome after out-of-hospital cardiac arrest (OHCA) is often poor, even when initial resuscitation succeeds. Lower tidal volumes (VTs) attenuate extrapulmonary organ injury in other disease states and are neuroprotective in preclinical models of critical illness.Objective: To evaluate the association between VT and neurocognitive outcome after OHCA.Methods: We performed a propensity-adjusted analysis of a twocenter retrospective cohort of patients experiencing OHCA who received mechanical ventilation for at least the first 48 hours of hospitalization. VT was calculated as the time-weighted average over the first 48 hours, in milliliters per kilogram of predicted body weight (PBW). The primary endpoint was favorable neurocognitive outcome (cerebral performance category of 1 or 2) at discharge.Measurements and Main Results: Of 256 included patients, 38% received time-weighted average VT greater than 8 ml/kg PBW during the first 48 hours. Lower VT was independently associated with favorable neurocognitive outcome in propensityadjusted analysis (odds ratio, 1.61; 95% confidence interval [CI], 1.13-2.28 per 1-ml/kg PBW decrease in VT; P = 0.008). This finding was robust to several sensitivity analyses. Lower VT also was associated with more ventilator-free days (b = 1.78; 95% CI, 0.39-3.16 per 1-ml/kg PBW decrease; P = 0.012) and shockfree days (b = 1.31; 95% CI, 0.10-2.51; P = 0.034). VT was not associated with hypercapnia (P = 1.00). Although the propensity score incorporated several biologically relevant covariates, only height, weight, and admitting hospital were independent predictors of VT less than or equal to 8 ml/kg PBW.Conclusions: Lower VT after OHCA is independently associated with favorable neurocognitive outcome, more ventilator-free days, and more shock-free days. These findings suggest a role for low-VT ventilation after cardiac arrest.

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“…Our results are also in line with a study that included 27 patients treated with TH and found that 67% of the TH-treated patients had normal cognition or very mild deficits. 22 Two small series found that a larger proportion (approximately 50%) of TH-treated cardiac arrest survivors had cognitive impairment. 23,24 One study of 43 patients found that 48% had cognitive impairment, half of whom had "mild" deficits.…”

mentioning

confidence: 99%

“…Most studies have similarly found that the most common cognitive domains affected after survival of cardiac arrest are memory and executive function. 12,13,15,22,24 In a systematic review (largely of patients not treated with TH), memory problems, followed by attention and executive dysfunction, were frequently encountered. 16 Clinicians who care for patients surviving OHCA should be aware of the possibility of cognitive deficits, even when neurologic outcome appears favorable in the acute phase.…”

mentioning

confidence: 99%

Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest

et al. 2013

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Objective: We aimed to study the long-term cognitive abilities of patients surviving out-of-hospital cardiac arrest who were treated with therapeutic hypothermia (TH). Methods:We prospectively identified and examined consecutive survivors of out-of-hospital cardiac arrest who underwent TH at our institution from June 2006 to May 2011. The results of brain imaging, serum neuron-specific enolase (NSE) measurements, and EEGs were recorded. We assessed cognitive domains using the modified Telephone Interview for Cognitive Status. An education-adjusted score of $32 was considered normal.Results: Of 133 total patients, 77 (58%) were alive at a median follow-up of 20 months (interquartile range 14-24 months). We interviewed 56 patients (73% of those alive). Median age was 67 years (range 24-88 years). Fifty-one patients (91%) were living independently. Modified Telephone Interview for Cognitive Status scores ranged from 16 to 41. Thirty-three (60%) were considered cognitively normal and 22 (40%) were cognitively impaired. The time to assessment did not differ among the cognitive outcomes (p 5 0.557). The median duration of coma was 2 days, possibly indicating that patients with severe anoxic injury were not included. Eighteen patients were not working at the time of their cardiac arrest (17 were retired and 1 was unemployed). Of the 38 patients who were working up to the time of the cardiac arrest, 30 (79%) returned to work. Cognitive outcome was not associated with age, time to return of spontaneous circulation, brain atrophy, or leukoaraiosis. Conclusions:The majority of surviving patients who underwent TH after cardiac arrest in this series had preserved cognitive function and were able to return to work.

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Cognitive and Neurophysiological Outcome of Cardiac Arrest Survivors Treated With Therapeutic Hypothermia

Cited by 105 publications

References 24 publications

Use of hypothermia in the intensive care unit

Use of hypothermia in the intensive care unit

Favorable Neurocognitive Outcome with Low Tidal Volume Ventilation after Cardiac Arrest

Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest

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