Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: data from a randomized controlled trial.

Marjaana Tiainen,Tero Varpula,Kirsi-Maija Kaukonen,Erja Poutiainen,Ville Pettilä,Tuomas Oksanen,Maaret Castrén,Markus Skrifvars

doi:10.1186/s13049-014-0084-9

Abstract

BackgroundTo 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.MethodsPatients 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.ResultsOf 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.ConclusionsFunctional 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.

Highlights

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
The prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) as the initial rhythm has improved, as up to 55% of hypothermia-treated OHCA-VF patients may achieve good outcome [1,2,3]
All postresuscitation patients in the Helsinki University Central Hospital (HUCH) area with witnessed OHCA caused by VF and admitted to the two participating intensive care units (ICU) from November 2004 to December 2006 were screened for the SUGARtrial

Summary

Introduction

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. The prognosis of patients resuscitated from out-of-hospital cardiac arrest (OHCA) with ventricular fibrillation (VF) as the initial rhythm has improved, as up to 55% of hypothermia-treated OHCA-VF patients may achieve good outcome [1,2,3]. Neurologic outcome after CA is commonly evaluated by Glasgow-Pittsburgh Cerebral Performance Categories (CPC) [6,7] This five-step category classification is simple, but it has a limited value in discriminating between mild and moderate brain injury [8]. The CPC classification does not comprise cognitive impairment in conscious

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