期刊论文详细信息
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: data from a randomized controlled trial
Maaret Castrén3  Tero Varpula2  Markus Skrifvars2  Ville Pettilä2  Kirsi-Maija Kaukonen2  Tuomas Oksanen2  Erja Poutiainen1  Marjaana Tiainen4 
[1] Institute of Behavioral Sciences, University of Helsinki, Helsinki, Finland;Intensive Care Units, Department of Anaesthesiology and Intensive Care Medicine, Helsinki University Hospital, Helsinki, Finland;Helsinki University and HUCH Emergency Care, Helsinki University Hospital, Helsinki, Finland;Department of Neurology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki 00029, Finland
关键词: Hypothermia;    Quality of life;    Cognition;    Neurological outcome;    Cardiac arrest;   
Others  :  1132258
DOI  :  10.1186/s13049-014-0084-9
 received in 2014-08-22, accepted in 2014-12-30,  发布年份 2015
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【 摘 要 】

Background

To study functional neurologic and cognitive outcome and health-related quality of life (HRQoL) in a cohort of patients included in a randomised controlled trial on glucose control following out-of-hospital cardiac arrest (OHCA) from ventricular fibrillation (VF) treated with therapeutic hypothermia.

Methods

Patients alive at 6 months after being discharged from the hospital underwent clinical neurological and extensive neuropsychological examinations. Functional outcome was evaluated with the Cerebral Performance Category scale, the modified Rankin scale and the Barthel Index. Cognitive outcome was evaluated by neuropsychological test battery including two measures of each cognitive function: cognitive speed, execution, memory, verbal skills and visuospatial performance. We also assessed quality of life with a HRQoL 15D questionnaire.

Results

Of 90 OHCA-VF patients included in the original trial, 57 were alive at 6 months. Of these, 52 (91%) were functionally independent and 54 (95%) lived at their previous home. Focal neurological deficits were scarce. Intact cognitive performance was observed in 20 (49%), mild to moderate deficits in 14 (34%) and severe cognitive deficits in 7 (17%) of 41 patients assessed by a neuropsychologist. Cognitive impairments were most frequently detected in executive and memory functions. HRQoL of the CA survivors was comparable to that of age- and gender matched population.

Conclusions

Functional outcome six months after OHCA and therapeutic hypothermia was good in the great majority of the survivors, and half of them were cognitively intact. Of note, the HRQoL of CA survivors did not differ from that of age- and gender matched population.

【 授权许可】

   
2015 Tiainen et al.; licensee BioMed Central.

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【 参考文献 】
  • [1]The Hypothermia After Cardiac Arrest Study Group: Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest N Engl J Med 2002, 346:549-56.
  • [2]Nielsen N, Hovdenes J, Nilsson F, Rubertsson S, Stammet P, Sunde K, Valsson F, Wanscher M, Friberg H: Hypothermia Network: Outcome, timing and adverse events in therapeutic hypothermia after out-of-hospital cardiac arrest. Acta Anaesthesiol Scand 2009, 53:926-34.
  • [3]Vaahersalo J, Hiltunen P, Tiainen M, Oksanen T, Kaukonen KM, Kurola J, Ruokonen E, Tenhunen J, Ala-Kokko T, Lund V, Reinikainen M, Kiviniemi O, Silfvast T, Kuisma M, Varpula T, Pettilä V: FINNRESUSCI Study Group: Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med 2013, 39:826-37.
  • [4]Engdahl J, Bång A, Karlson BW, Lindqvist J, Sjölin M, Herlitz J: Long-term mortality among patients discharged alive after out-of-hospital cardiac arrest does not differ markedly compared with that of myocardial infarct patients without out-of-hospital cardiac arrest. Eur J Emerg Med 2001, 8:253-61.
  • [5]Lindner T, Vossius C, Mathiesen WT, Søreide E: Life years saved, standardised mortality rates and causes of death after hospital discharge in out-of-hospital cardiac arrest survivors. Resuscitation 2014, 85:671-5.
  • [6]Jennet B, Bond M: Assessment of outcome after severe brain damage. Lancet 1975, 1:480-4.
  • [7]Brain Resuscitation Clinical Trial II Study Group: A randomized clinical study of a calcium-entry blocker (lidoflazine) in the treatment of comatose survivors of cardiac arrest N Engl J Med 1991, 324:1225-31.
  • [8]Raina KD, Callaway C, Rittenberger JC, Holm MB: Neurological and functional status following cardiac arrest: method and tool utility. Resuscitation 2008, 79:249-56.
  • [9]Tiainen M, Poutiainen E, Kovala T, Takkunen O, Häppölä O, Roine RO: Cognitive and neurophysiological outcome of cardiac arrest survivors treated with therapeutic hypothermia. Stroke 2007, 38:2303-8.
  • [10]Bro-Jeppesen J, Kjaergaard J, Horsted TI, Wanscher MC, Nielsen SL, Rasmussen LS, Hassager C: The impact of therapeutic hypothermia on neurological function and quality of life after cardiac arrest. Resuscitation 2009, 80:171-6.
  • [11]Oksanen T, Skrifvars MB, Varpula T, Kuitunen A, Pettilä V, Nurmi J, Castrén M: Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med 2007, 33:2093-100.
  • [12]Rankin L: Cerebral vascular accidents in patients over the age of 60. II. Prognosis. Scott Med J 1957, 2:200-15.
  • [13]Mahoney FI, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 1965, 14:61-5.
  • [14]Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, Spilker J, Holleran R, Eberle R, Hertzberg V, Rorick M, Moomaw CJ, Walker M: Measurements of acute cerebral infarction: a clinical examination scale. Stroke 1989, 20:864-70.
  • [15]Wechsler D: Wechsler adult intelligence scale - revised. The Psychological Corporation, San Antonio (Tx); 1981.
  • [16]Wechsler D: Wechsler memory scale - revised. The Psychological Corporation, London; 1987.
  • [17]Wechsler D: WMS- III. The Psychological Corporation, London; 1998.
  • [18]Lezak MD, Howieson DB, Loring DW: Neuropsychological assessment. 4th edition. Oxford University Press, New York; 2004.
  • [19]Vilkki J: Hemi-inattention in visual search for parallel lines after focal cerebral lesions. J Clin Exp Neuropsychol 1989, 11:319-31.
  • [20]Sintonen H: The 15D instrument of health-related quality of life: properties and applications. Ann Med 2001, 33:328-36.
  • [21]Loponen P, Luther M, Korpilahti K, Wistbacka JO, Huhtala H, Laurikka J, Tarkka MR: HRQoL after coronary artery bypass grafting and percutaneous coronary intervention for stable angina. Scand Cardiovasc J 2009, 43:94-9.
  • [22]Naess H, Lunde L, Brogger J: The effects of fatigue, pain, and depression on quality of life in ischemic stroke patients: the Bergen Stroke Study. Vasc Health Risk Manag 2012, 8:407-13.
  • [23]Saarni SI, Härkänen T, Sintonen H, Suvisaari J, Koskinen S, Aromaa A, Lönnqvist J: The impact of 29 chronic conditions in health-related quality of life: a general population survey in Finland using 15D and EQ-5D. Qual Life Res 2006, 15:1403-14.
  • [24]Lundgren-Nilsson Å, Rosén H, Hofgren C, Sunnerhagen KS: The first year after successful cardiac resuscitation: Function, activity, participation and quality of life. Resuscitation 2005, 66:285-9.
  • [25]Cronberg T, Lilja G, Rundgren M, Friberg H, Widner H: Long-term neurological outcome after cardiac arrest and therapeutic hypothermia. Resuscitation 2009, 80:1119-23.
  • [26]Tiainen M, Roine RO, Pettilä V, Takkunen O: Serum neuron-specific enolase and S-100B protein in cardiac arrest patients treated with hypothermia. Stroke 2003, 34:2881-6.
  • [27]Pandharipande PP, Girard TD, Jackson JC, Morandi A, Thompson JL, Pun BT, Brummel NE, Hughes CG, Vasilevskis EE, Shintani AK, Moons KG, Geevarghese SK, Canonico A, Hopkins RO, Bernard GR, Dittus RS, Ely EW: BRAIN-ICU Study Investigators: Long-term cognitive impairment after critical illness. N Engl J Med 2013, 369:1306-16.
  • [28]Torgersen J, Strand K, Bjelland TW, Klepstad P, Kvåle R, Søreide E, et al.: Cognitive dysfunction and health-related quality of life after a cardiac arrest and therapeutic hypothermia. Acta Anaesthesiol Scand 2010, 54:721-8.
  • [29]Fugate JE, Moore SA, Knopman DS, Claassen DO, Wijdicks EF, White RD, Rabinstein AA: Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest. Neurology 2013, 81:40-5.
  • [30]Kragholm K, Skovmoeller M, Christensen AL, Fonager K, Tilsted HH, Kirkegaard H, Haas I DE, Rasmussen BS: Employment status 1 year after out-of-hospital cardiac arrest in comatose patients treated with therapeutic hypothermia. Acta Anaesthesiol Scand 2013, 57:936-43.
  • [31]Wallin E, Larsson IM, Rubertsson S, Kristofferzon ML: Cardiac arrest and hypothermia treatment–function and life satisfaction among survivors in the first 6 months. Resuscitation 2014, 85:538-43.
  • [32]Hsu JW, Madsen CD, Callaham ML: Quality-of-life and formal functional testing of survivors of out-of-hospital cardiac arrest correlates poorly with traditional neurologic outcome scales. Ann Emerg Med 1996, 28:597-605.
  • [33]Saner H, Borner Rodriguez E, Kummer-Bangerter A, Schuppel R, von Planta M: Quality of life in long-term survivors of out-of-hospital cardiac arrest. Resuscitation 2002, 53:7-13.
  • [34]Bunch TJ, White RD, Gersh BJ, Meverden RA, Hodge DO, Ballman KV, Hammill SC, Shen WK, Packer DL: Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med 2003, 348:2626-33.
  • [35]Stiell I, Nichol G, Wells G, De Maio V, Nesbitt L, Blackburn J, Spaite D: OPALS Study Group: Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation 2003, 108:1939-44.
  • [36]van Alem AP, Waalewijn RA, Koster RW, de Vos R: Assessment of quality of life and cognitive function after out-of-hospital cardiac arrest with successful resuscitation. Am J Cardiol 2004, 93:131-5.
  • [37]Rea TD, Paredes VL: Quality of life and prognosis among survivors of out-of-hospital cardiac arrest. Curr Opin Crit Care 2004, 10:218-23.
  • [38]Elliott VJ, Rodgers DL, Brett SJ: Systematic review of quality of life and other patients-centred outcomes after cardiac arrest survival. Resuscitation 2011, 82:247-56.
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