Cognitive Assessment in Adult Cardiac Arrest Survivors: What Is Known and How Shall We Move Forward?
DOI:
https://doi.org/10.1891/1748-6254.12.3.56Keywords:
cognitive, scoping, cardiac arrest, rehabilitation, OHCAAbstract
Background: Cardiac arrest (CA) remains the leading cause of premature deaths. Survivors often suffer from ischaemia-reperfusion injuries,which lead to neurological damage, cognitive impairment and psychosocial problems. While most survivors have to be assessed and deemed neurologically and functionally fit enough before discharge, adequacy of cognitive function is often neglected. This leads to problems with memory, attention, and executive function that are important for daily living.
Aim: This study aims to provide an overview of existing literature regarding the use of cognitive assessment in adult CA survivors.
Methods: A scoping review was conducted.
Results/Findings: 62 articles were included and the existing relevant literature on the use of cognitive assessment can be mapped into the following themes: neurological–cognitive–psychosocial sequelae, effects of therapeutic hypothermia, prediction of cognitive function, adequacy of cognitive assessment tools, and effectiveness of post-CA rehabilitation interventions with cognitive domain. There is currently no consensus on the cognitive screening tool for cardiac arrest survivors although it is clear that they suffer from cognitive impairments especially memory and executive function.
Conclusion: Routine cognitive testing should be part of follow-up care especially alongside cardiac rehabilitation to enhance patient outcomes and secondary prevention through complex self-care. This may decrease mortality, morbidity, and disease burden on an individual, national, and even global level.
References
Anderson, C. A., & Arciniegas, D. B. (2010). Cognitive sequelae of hypoxic-ischemic brain injury: A review. NeuroRehabilitation, 26(1), 47–63.
Arksey, H., & O'Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19–32. doi:10.1080/1364557032000119616
Arrich, J., Holzer, M., Havel, C., Müllner, M., & Herkner, H. (2012). Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Systematic Review, 9(9), 1–34. doi:10.1002/14651858.CD004128.pub3
Beesems, S. G., Wittebrood, K. M., Haan de, J. R., & Koster, R. W. (2014). Cognitive function and quality of life after successful resuscitation from cardiac arrest. Resuscitation, 85(9), 1269–1274. doi:10.1016/j.resuscitation.2014.05.027
Berdowski, J., Berg, R. A., Tijssen, J. G., & Koster, R. W. (2010). Global incidences of out-of-hospital cardiac arrest and survival rates: systematic review of 67 prospective studies. Resuscitation, 81(11), 1479–1487.
Boyce, L. W., & Goossens, P. H. (2017). Rehabilitation after cardiac arrest: Integration of neurologic and cardiac rehabilitation. Seminars in neurology, 37(1), 094–102. doi:10.1055/s-0036-1593860
Boyce, L. W., Reinders, C. C., Volker, G., Los, E., van Exel, H. J., Vlieland, T. P. V., & Goossens, P. H. (2017). Out-of-hospital cardiac arrest survivors with cognitive impairments have lower exercise capacity. Resuscitation, 115, 90–95. doi:10.1016/j.resuscitation.2017.04.010
Boyce-van der Wal, L. W., Volker, W. G., Vlieland, T. V., van den Heuvel, D. M. J., & Goossens, P. H. (2015). Cognitive problems in patients in a cardiac rehabilitation program after an out-of-hospital cardiac arrest. Resuscitation, 93, 63–68. doi:10.1016/j.resuscitation.2015.05.029
Buanes, E. A., Gramstad, A., Søvig, K. K., Hufthammer, K. O., Flaatten, H., Husby, T., … Heltne, J. K. (2015). Cognitive function and health-related quality of life four years after cardiac arrest. Resuscitation, 89, 13–18. doi:10.1016/j.resuscitation.2014.12.021
Chen, C. T., Chiu, P. C., Tang, C. Y., Lin, Y. Y., Lee, Y. T., How, C. K., & Huang, M. S. (2016). Prognostic factors for survival outcome after in-hospital cardiac arrest: An observational study of the oriental population in Taiwan. Journal of the Chinese Medical Association, 79(1), 11–16. doi:10.1016/j.jcma.2015.07.011
Cowan, M. J., Pike, K. C., & Budzynski, H. K. (2001). Psychosocial nursing therapy following sudden cardiac arrest: Impact on two-year survival. Nursing Research, 50(2), 68–76. doi:10.1097/00006199-200103000-00002
Cronberg, T., & Lilja, G. (2015). Cognitive decline after cardiac arrest—It is more to the picture than hypoxic brain injury. Resuscitation, 91, A3–A4. doi:10.1016/j.resuscitation.2015.03.002
Cronberg, T., Lilja, G., Horn, J., Kjaergaard, J., Wise, M. P., Pellis, T., & Erlinge, D. (2015). Neurologic function and health-related quality of life in patients following targeted temperature management at 33°C vs 36°C after out-of-hospital cardiac arrest: A randomized clinical trial. Journal of American Medical Association Neurology, 72(6), 634–641. doi:10.1001/jamaneurol.2015.0169
Cronberg, T., Lilja, G., Rundgren, M., Friberg, H., & Widner, H. (2009). Long-term neurological outcome after cardiac arrest and therapeutic hypothermia. Resuscitation, 80(10), 1119–1123. doi:10.1016/j.resuscitation.2009.06.021
Davies, S. E., Rhys, M., Voss, S., Greenwood, R., Thomas, M., & Benger, J. R. (2017). Psychological wellbeing in survivors of cardiac arrest, and its relationship to neurocognitive function. Resuscitation, 111, 22–25. doi:10.1016/j.resuscitation.2016.11.004
Dostálová, V., Sedlá?ek, K., B?lohlávek, J., Turek, R., Pretl, M., & Bezdicek, O. (2016). Psychosocial sequelae following cardiac arrest. Cor et Vasa, 59(3), e222–e228. doi:10.1016/j.crvasa.2016.11.012
Elliott, V. J., Rodgers, D. L., & Brett, S. J. (2011). Systematic review of quality of life and other patient-centred outcomes after cardiac arrest survival. Resuscitation, 82(3), 247–256. doi:10.1016/j.resuscitation.2010.10.030
Fan, K. L., Leung, L. P., & Siu, Y. C. (2017). Out-of-hospital cardiac arrest in Hong Kong: A territory-wide study. Hong Kong Medical Journal, 23(1), 48–53. doi:10.12809/hkmj166046
Fugate, J. E., Moore, S. A., Knopman, D. S., Claassen, D. O., Wijdicks, E. F., White, R. D., & Rabinstein, A. A. (2013). Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest. Neurology, 81(1), 40–45. doi:10.1212/WNL.0b013e318297ee7e
Girotra, S., Chan, P. S., & Bradley, S. M. (2015). Post-resuscitation care following out-of-hospital and in-hospital cardiac arrest. Heart, 101(24), 1943–1949. doi:10.1136/heartjnl-2015-307450
Grubb, N. R., Simpson, C., Sherwood, R. A., Abraha, H. D., Cobbe, S. M., O'carroll, R. E., & Fox, K. A. (2007). Prediction of cognitive dysfunction after resuscitation from out-of-hospital cardiac arrest using serum neuron-specific enolase and protein S-100. Heart, 93(10), 1268–1273. doi:10.1136/hrt.2006.091314
Haydon, G., Riet, P., & Maguire, J. (2017). Survivors' quality of life after cardiopulmonary resuscitation: An integrative review of the literature. Scandinavian Journal of Caring Sciences, 31(1), 6–26. doi:10.1111/scs.12323
Hofgren, C., Lundgren-Nilsson, Å., Esbjörnsson, E., & Sunnerhagen, K. S. (2008). Two years after cardiac arrest; cognitive status, ADL function and living situation. Brain Injury, 22(12), 972–978. doi:10.1080/02699050802491289
Howard, R. S., Holmes, P. A., & Koutroumanidis, M. A. (2011). Hypoxic-ischaemic brain injury. Practical Neurology, 11(1), 4–18. doi:10.1136/jnnp.2010.235218
Iannacone, S., Leary, M., Esposito, E. C., Ruparel, K., Savitt, A., Mott, A., & Abella, B. S. (2014). Feasibility of cognitive functional assessment in cardiac arrest survivors using an abbreviated laptop-based neurocognitive battery. Therapeutic Hypothermia and Temperature Management, 4(3), 131–136. doi:10.1089/ther.2014.0007
Jentzer, J. C., Clements, C. M., Wright, R. S., White, R. D., & Jaffe, A. S. (2016). Improving survival from cardiac arrest: A review of con-temporary practice and challenges. Annals of Emergency Medicine, 68(6), 678–689. doi:10.1016/j.annemergmed.2016.05.022
Karnatovskaia, L. V., Wartenberg, K. E., & Freeman, W. D. (2014). Therapeutic hypothermia for neuroprotection: History, mechanisms, risks, and clinical applications. Neurohospitalist, 4(3), 153–163. doi:10.1177/1941874413519802
Ketilsdottir, A., Albertsdottir, H. R., Akadottir, S. H., Gunnarsdottir, T. J., & Jonsdottir, H. (2014). The experience of sudden cardiac arrest: Becoming reawakened to life. European Journal of Cardiovascular Nursing, 13(5), 429–435. doi:10.1177/1474515113504864
Koller, A. C., Rittenberger, J. C., Repine, M. J., Morgan, P. W., Kristan, J., & Callaway, C. W. (2017). Comparison of three cognitive exams in cardiac arrest survivors. Resuscitation, 116, 98–104. doi:10.1016/j.resuscitation.2017.04.011
Lilja, G., Nielsen, N., Friberg, H., Horn, J., Kjaergaard, J., Pellis, T., & Cronberg, T. (2015). Long-term neurological outcome of out-of-hospital cardiac arrest survivors. Neurocritical Care, 23(Suppl. 1), 12.
Lim, C., Alexander, M. P., LaFleche, G., Schnyer, D. M., & Verfaellie, M. (2004). The neurological and cognitive sequelae of cardiac arrest. Neurology, 63(10), 1774–1778. doi:10.1212/01.WNL.0000144189.83077.8E
Lippi, G., Aloe, R., Numeroso, F., & Cervellin, G. (2011). The significance of protein S-100B testing in cardiac arrest patients. Clinical Biochemistry, 44(8), 567–575. doi:10.1016/j.clinbiochem.2011.03.133
Lundgren-Nilsson, Å., Rosén, H., Hofgren, C., & Sunnerhagen, K. S. (2005). The first year after successful cardiac resuscitation: Function, activity, participation and quality of life. Resuscitation, 66(3), 285–289. doi:10.1016/j.resuscitation.2005.04.001
Mak, M., Moulaert, V. R. M., Pijls, R. W., & Verbunt, J. A. (2016). Measuring outcome after cardiac arrest: Construct validity of Cerebral Performance Category. Resuscitation, 100, 6–10. doi:10.1016/j.resuscitation.2015.12.005
Mehra, R. (2007). Global public health problem of sudden cardiac death. Journal of Electrocardiology, 40(6), S118–S122. doi:10.1016/j.jelectrocard.2007.06.023
Middelkamp, W., Moulaert, V. R., Verbunt, J. A., van Heugten, C. M., Bakx, W. G., & Wade, D. T. (2007). Life after survival: Long-term daily life functioning and quality of life of patients with hypoxic brain injury as a result of a cardiac arrest. Clinical Rehabilitation, 21(5), 425–431. doi:10.1177/0269215507075307
Moulaert, V., van Heugten, C. M., Winkens, B., Bakx, W., de Krom, M., Gorgels, A., … Verbunt, J. (2013). New psychosocial intervention improves quality of life after cardiac arrest: Results of a randomised controlled trial. Resuscitation, 84(1), S1–S2. doi:10.1016/j.resuscitation.2013.08.020
Moulaert, V. R., Goossens, M., Heijnders, I. L., Verbunt, J. A., & van Heugten, C. M. (2016). Early neurologically focused follow-up after cardiac arrest is cost-effective: A trial-based economic evaluation. Resuscitation, 106, 30–36. doi:10.1016/j.resuscitation.2016.06.015
Moulaert, V. R., van Heugten, C. M., Gorgels, T. P., Wade, D. T., & Verbunt, A. (2017). Long-term Outcome after survival of a cardiac arrest: A prospective longitudinal cohort study. Neurorehabilitation and Neural Repair, 31(6), 530–539. doi:10.1177/1545968317697032
Moulaert, V. R., van Heugten, C. M., Winkens, B., Bakx, W. G., de Krom, A., Gorgels, T. P., … Verbunt, J. (2015). Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: A randomised controlled trial. International Journal of Cardiology, 193, 8–16. doi:10.1016/j.ijcard.2015.04.229
Moulaert, V. R., Verbunt, J. A., van Heugten, C. M., & Wade, D. T. (2009). Cognitive impairments in survivors of out-of-hospital cardiac arrest: A systematic review. Resus-citation, 80(3), 297–305. doi:10.1016/j.resuscitation.2008.10.034
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., … Howard, V. J. (2016). Heart disease and stroke statistics—2016 update. Circulation, 133(4), e38–e360. doi:10.1161/CIR.0000000000000350
Nichol, G., Guffey, D., Stiell, I. G., Leroux, B., Cheskes, S., Idris, A., & Rea, T. D. (2015). Post-discharge outcomes after resuscitation from out-of-hospital cardiac arrest: A ROC PRIMED substudy. Resuscitation, 93, 74–81. doi:10.1016/j.resuscitation.2015.05.011
Nolan, J. P., Perkins, G. D., & Soar, J. (2015). Improving survival after out-of-hospital cardiac arrest. The British Medical Journal, 351(h4989), 1–2. doi:10.1136/bmj.h4989
Nunes, B., Pais, J., Garcia, R., Magalhães, Z., Granja, C., & Silva, M. C. (2003). Cardiac arrest: Long-term cognitive and imaging analysis. Resuscitation, 57(3), 287–297. doi:10.1016/S0300-9572(03)00033-9
Ong, M. E. H., Do Shin, S., De Souza, N. N. A., Tanaka, H., Nishiuchi, T., Song, K. J., Sarah, A. K. (2015). Outcomes for out-of-hospital cardiac arrests across 7 countries in. Asia: The Pan Asian Resuscitation Outcomes Study (PAROS). Resuscitation, 96, 100–108. doi:10.1016/j.resuscitation.2015.07.026
Ørbo, M., Aslaksen, P. M., Larsby, K., Norli, L., Schäfer, C., Tande, P. M., & Anke, A. (2014). Determinants of cognitive outcome in survivors of out-of-hospital cardiac arrest. Resuscitation, 85(11), 1462–1468. doi:10.1016/j.resuscitation.2014.08.010
Perez, C. A., Samudra, N., & Aiyagari, V. (2016). Cognitive and functional consequence of cardiac arrest. Current Neurology and Neuroscience Reports, 16(8), 1–10. doi:10.1007/s11910-016-0669-y
Peters, M. D., Godfrey, C. M., Khalil, H., McInerney, P., Parker, D., & Soares, C. B. (2015). Guidance for conducting systematic scoping reviews. International Journal of Evidence-Based Healthcare, 13(3), 141–146. doi:10.1097/XEB.0000000000000050
Polanowska, K. E., Sarzy?ska-D?ugosz, I. M., Paprot, A. E., Sikorska, ?., Seniów, J. B., Karpi?ski, G., & Cz?onkowska, A. (2014). Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: A prospective pilot study. Kardiologia Polska (Polish Heart Journal), 72(9), 814–822. doi:10.5603/KP.a2014.0087
Prohl, J., Bodenburg, S., & Rustenbach, S. J. (2009). Early prediction of long-term cognitive impairment after cardiac arrest. Journal of the International Neuropsychological Society, 15(3), 344–353. doi:10.1017/S1355617709090493
Prohl, J., Röther, J., Kluge, S., de Heer, G., Liepert, J., Bodenburg, S., … Kreymann, G. (2007). Prediction of short-term and long-term outcomes after cardiac arrest: A prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations. Critical Care Medicine, 35(5), 1230–1237. doi:10.1097/01.CCM.0000261892.10559.85
Pusswald, G., Fertl, E., Faltl, M., & Auff, E. (2000). Neurological rehabilitation of severely disabled cardiac arrest survivors. Part II. Life situation of patients and families after treatment. Resuscitation, 47(3), 241–248. doi:10.1016/S0300-9572(00)00240-9
Rittenberger, J. C., Raina, K., Holm, M. B., Kim, Y. J., & Callaway, C. W. (2011). Association between Cerebral Performance Category, Modified Rankin Scale, and discharge disposition after cardiac arrest. Resuscitation, 82(8), 1036–1040. doi:10.1016/j.resuscitation.2011.03.034
Steinbusch, C. V., van Heugten, C. M., Rasquin, S. M., Verbunt, J. A., & Moulaert, V. R. (2017). Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: A prospective longitudinal cohort study. Resuscitation, 120, 132–137. doi:10.1016/j.resuscitation.2017.08.007
Sulzgruber, P., Kliegel, A., Wandaller, C., Uray, T., Losert, H., Laggner, A. N., & Kliegel, M. (2015). Survivors of cardiac arrest with good neurological outcome show considerable impairments of memory functioning. Resuscitation, 88, 120–125. doi:10.1016/j.resuscitation.2014.11.009
Tiainen, M., Poutiainen, E., Oksanen, T., Kaukonen, K. M., Pettilä, V., Skrifvars, M., & Castrén, M. (2015). Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: Data from a randomized controlled trial. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 23(1), 12. doi:10.1186/s13049-014-0084-9
Torgersen, J., Strand, K., Bjelland, T. W., Klepstad, P., Kvåle, R., Søreide, E., & Flaatten, H. (2010). Cognitive dysfunction and health?related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiologica Scandinavica, 54(6), 721–728. doi:10.1111/j.1399-6576.2010.02219.x
Whitehead, L., Perkins, G., Biggerstaff, D., Couper, K., & Haywood, K. (2015). Exploring the lived experience of surviving an out of hospital cardiac arrest: Understanding what health outcomes really matter to patients. Resuscitation, 96(Suppl. 1), 108. doi:10.1016/j.resuscitation.2015.09.255
