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July 02, 2013; 81 (1) Article

Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest

Jennifer E. Fugate, Samuel A. Moore, David S. Knopman, Daniel O. Claassen, Eelco F.M. Wijdicks, Roger D. White, Alejandro A. Rabinstein
First published May 17, 2013, DOI: https://doi.org/10.1212/WNL.0b013e318297ee7e
Jennifer E. Fugate
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Samuel A. Moore
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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David S. Knopman
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Daniel O. Claassen
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Eelco F.M. Wijdicks
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Roger D. White
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Alejandro A. Rabinstein
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
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Citation
Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest
Jennifer E. Fugate, Samuel A. Moore, David S. Knopman, Daniel O. Claassen, Eelco F.M. Wijdicks, Roger D. White, Alejandro A. Rabinstein
Neurology Jul 2013, 81 (1) 40-45; DOI: 10.1212/WNL.0b013e318297ee7e

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Abstract

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 = 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.

GLOSSARY

CPC=
Cerebral Performance Category;
IQR=
interquartile range;
NSE=
neuron-specific enolase;
OHCA=
out-of-hospital cardiac arrest;
ROSC=
return of spontaneous circulation;
TH=
therapeutic hypothermia;
TICS-m=
Telephone Interview for Cognitive Status, modified

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received October 2, 2012.
  • Accepted in final form March 14, 2013.
  • © 2013 American Academy of Neurology
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