Poster 130: Cognitive impairments after cardiorespiratory arrest: a report of 3 cases.

Abstract

Setting: Tertiary care pediatric hospital. Patients: Three boys, ages 8, 12, and 14 years, diagnosed with hypoxic-ischemic encephalopathy after out-of-hospital cardiorespiratory arrest. Case Descriptions: Within a 1-month period, all subjects were admitted to the rehabilitation unit. Etiologies included submersion in grain truck resulting in cardiorespiratory arrest, cardiorespiratory arrest secondary to congenital heart abnormality, and cardiorespiratory arrest with unknown etiology, thought possibly to be due to hyperthermia. Assessment/Results: Initial computed tomography scans were negative in all subjects. In 2 subjects, magnetic resonance imaging (MRI) revealed mild volume loss and signal intensity changes consistent with ischemic injury. The third subject’s MRI was normal. The mean length of stay (LOS) in the acute setting was 10 days (range, 4–23d). All subjects were transferred to the rehabilitation unit with a mean LOS of 30 days (range, 19–45d). On admission, impairments were found in the domains of swallowing, mobility, dressing, bathing, and cognition. At discharge, all were independent in the above areas except that each continued to have significant cognitive impairments. Neuropsychologic testing between 2 and 6 months postinjury revealed that, in the face of relatively preserved semantic knowledge and word identification, all subjects demonstrated significant problems with new learning and memory, attention, executive functions, processing speed, and fine-motor skills. 2 of the subjects displayed additional deficits in visuospatial and language skills. Discussion: Few children survive out-of-hospital cardiorespiratory arrest; outcomes in survivors being universally poor. This report describes a unique group of children who survived a cardiorespiratory arrest and had primarily cognitive sequelae. The severity of the impairments in all 3 subjects significantly impacts their daily home and school functioning. Conclusion: Isolated cognitive impairments after out-of-hospital cardiorespiratory arrest can be seen in children although these findings are not classically described in studies.