Abstract
AimTo establish incidence, phenotype, long-term functional outcome, and early EEG predictors of delirium after cardiac arrest. MethodsThis is an ad hoc analysis of a prospective cohort study on outcome prediction of comatose patients after cardiac arrest. Patients with recovery of consciousness, who survived until hospital discharge, were subdivided in groups with and without delirium based on psychiatric consultation. Delirium phenotype and medical treatment were retrieved from patient files. All other data were prospectively collected. We used univariate analyses of baseline and early EEG characteristics for identification of possible delirium predictors. Association of delirium with neurological recovery at six months was analyzed with multinomial logistic regression analysis. ResultsOf 233 patients, 141 survived until hospital discharge, of whom 47 (33%) were diagnosed with delirium. There were no differences in baseline characteristics between patients with and without delirium. All delirious patients were treated with relatively high dosages of psychopharmaceuticals, mostly haloperidol and benzodiazepine agonists. Prevalent characteristics were disturbed cognition, perception and psychomotor functioning (98%). Half of the patients had language disorders or shouting. Delirium was associated with longer ICU and hospital admission, and more frequent discharge to rehabilitation centre or nursing home. There was a trend towards poorer neurological recovery. EEG measurements within 12 h after cardiac arrest could predict delirium with 91% specificity and 40% sensitivity. DiscussionDelirium is common after cardiac arrest, and probably leads to longer hospitalization and poorer outcome. Optimal treatment is unclear. Early EEG holds potential to identify patients at risk.
Highlights
Patients who survive a comatose state after cardiac arrest are at risk of delirium
The reported incidence of delirium is 30À80% in patients admitted to an intensive care unit (ICU)[4,5] and up to 100% in cardiac arrest survivors treated with mild therapeutic hypothermia.[6]
Patients with recovery of consciousness, who survived until hospital discharge, were subdivided in groups with and without delirium based on psychiatric consultation
Summary
Patients who survive a comatose state after cardiac arrest are at risk of delirium. Delirium is a clinical syndrome defined by disturbances in cognition and behaviour in medically ill patients. The diagnosis of delirium is based on fluctuating disturbances in attention, awareness, and cognition, without a direct cause, such as specific medical conditions or neurocognitive disorders. The reported incidence of delirium is 30À80% in patients admitted to an intensive care unit (ICU)[4,5] and up to 100% in cardiac arrest survivors treated with mild therapeutic hypothermia.[6] The origin of delirium is often multifactorial. In patients after cardiac arrest, both postanoxic encephalopathy and treatments like induced hypothermia or sedative medication may play a role. Delirium is associated with higher mortality, prolonged hospitalization, and an increased risk of cognitive impairment after discharge.[5]
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