Abstract
Background Recent studies have presented the effects of cardiac arrest on long-term cognitive function and quality of life. However, no study has evaluated cognitive function in the early stage after regaining consciousness. Purpose The objectives of this study were to analyse the incidence, clinical course, and associated factors of cognitive impairment of cardiac arrest survivors in intensive care unit (ICU). Patients and methods We administered the Mini-Mental State Examination (MMSE) to cardiac arrest survivors who were treated with targeted temperature management (TTM) immediately after regaining consciousness. Patients whose MMSE scores indicated impaired cognitive function (MMSE < 24) were retested before ICU discharge. Results In 92 patients, the median MMSE score was 21.0 (interquartile range (IQR), 16.0–24.0), and cognitive impairment was found in 64 patients. Fifty-three patients completed follow-up MMSEs, and the median scores were 20.0 (IQR, 13.5–23.0) for the first and 25.0 (IQR, 21.5–28.0) for the last test. Of the specific domains, recall (0.0 (IQR, 0.0–1.0) to 2.0 (IQR, 1.0–3.0)) and attention/calculation (3.0 (IQR, 1.0–4.0) to 4.0 (IQR, 2.0–5.0)) were the most affected domains until ICU discharge. The factors that were correlated with cognitive impairment on the last MMSE were older age (OR, 1.07 (95% CI, 1.01–1.14), p=0.016), increased time to return of spontaneous circulation (ROSC) (OR, 1.08 (95% CI, 1.02–1.15), p=0.012), and length of hospital stay (OR, 1.07 (95% CI, 1.00–1.14), p=0.044). Conclusions Cognitive impairments were common immediately after patients regained consciousness but recovered substantially before ICU discharge. Recall and attention/calculation still were impaired until ICU discharge, and older age, increased time to ROSC, and LOS were associated with this cognitive decline.
Highlights
Cardiac arrest is a major health problem [1] and has a yearly incidence of approximately 50–110 per 100000 people worldwide [2]
We evaluated some confounding variables for Mini-Mental State Examination (MMSE) score. e total dose of midazolam administered to patients during temperature management (TTM) was analysed. e time to MMSE was defined as the median number of hospital days on which the MMSE was conducted, and the time to obey was recorded when the patient gave a meaningful response to verbal commands
212 patients did not regain consciousness, and 13 patients were excluded because of intensive care unit (ICU) discharge before MMSE examination (n 6), poor neurologic status (n 4), or missing data (n 3)
Summary
Cardiac arrest is a major health problem [1] and has a yearly incidence of approximately 50–110 per 100000 people worldwide [2]. No study has evaluated cognitive function in the intensive care unit (ICU) early after regaining consciousness, and the process of cognitive function recovery has not been entirely presented. Recent studies have presented the effects of cardiac arrest on long-term cognitive function and quality of life. E objectives of this study were to analyse the incidence, clinical course, and associated factors of cognitive impairment of cardiac arrest survivors in intensive care unit (ICU). We administered the Mini-Mental State Examination (MMSE) to cardiac arrest survivors who were treated with targeted temperature management (TTM) immediately after regaining consciousness. Cognitive impairments were common immediately after patients regained consciousness but recovered substantially before ICU discharge. Recall and attention/calculation still were impaired until ICU discharge, and older age, increased time to ROSC, and LOS were associated with this cognitive decline
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