Elsevier

Resuscitation

Volume 77, Issue 1, April 2008, Pages 46-50
Resuscitation

Clinical paper
Long-term cognitive outcome in teenage survivors of arrhythmic cardiac arrest

https://doi.org/10.1016/j.resuscitation.2007.10.024Get rights and content

Summary

Background

Sudden cardiac arrest (SCA) can be the first sign of ventricular arrhythmia in teenagers. Neurocognitive problems are common after successful resuscitation. We studied cognitive function in teenage survivors of SCA, including emotional status and coping ability.

Method

Ten SCA survivors, aged 11–19 years, had neuropsychological tests within a few weeks of resuscitation. Awareness status, orientation, episodic and semantic memory, basic auditory-visual functions, praxis and speech, short-term memory, ability to learn new verbal and visual material were assessed. These tests were repeated at about 6 months.

Results

Eight patients had an initial assessment; one boy remained in a coma and one was making simple emotional contact, revealing intensified mixed aphasia and dyskinesia. Six patients had severe disturbances of memory, motor functions and praxis. After 6 months, four patients had no neurocognitive disturbance. Four patients had memory impairment making school education difficult. Two patients were totally dependent on caregivers. Because of the absence of symptoms before SCA, and amnesia relating to the SCA episodes, patients had problems accepting their heart problems and limitations resulting from it.

Conclusion

Teenagers surviving SCA have significant neurcognitive and psychological problems. They need psychological care and guidance in understanding their condition.

Section snippets

Material and methods

Teenager SCA survivors hospitalised between 2003 and 2006, and who attended two specialist arrhythmia clinics treatment were studied. Subjects were referred for a cardiology assessment by the centres where initial resuscitation had taken place. The time between SCA to admission to our clinics and first neuropsychological tests varied from 5 days to 2 months. Information about the original SCA and resuscitation (bystander resuscitation, paramedics, hospital) was obtained from medical records.

Results

The group consisted of eight boys and two girls, aged from 11 to 19 years (Table 1). Six of them were diagnosed with Wolff-Parkinson-White (WPW) syndrome and four of them with long-QT syndrome. One girl (patient 4) had a previous history of arrhythmias and was being investigated for this at the time of her SCA. SCA was the first sign of cardiac disease in the others. The patients with WPW were treated by radiofrequency ablation of their atrioventricular accessory pathway. The patients with

Discussion

We have analysed neurocognitive functions in teenage survivors of SCA. Most experienced significant neurocognitive dysfunctions during the first days and weeks following SCA. The problems observed were connected with physical skills, audio-visual function and speech, and different aspects of memory. At 6th month there was significant improvement in terms of speech, audio-visual function and movements; however, in some patients memory disturbances remained. Despite improvement since the initial

Limitations of the study

The main limitation of the study is a small number of subjects. Moreover, the group was varied in terms of patients’ age and duration of time between SCA and the first examination. Consequently, statistical analyses and generalisation of observations are not possible and therefore the study should be treated as a preliminary exploration of this subject.

Conflict of interest

None.

References (12)

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    Accordingly, conditions with cerebral hypoxia-ischemia often lead to a dysfunctional paralimbic network with associated failing conscious self-awareness. Such consequences are seen following neonatal hypoxia-ischemia with deficient autoregulation in the newborn infant, particularly in prematurity (Lou, 1996), following heart failure (Kumar et al., 2011), in the long-term cognitive outcome in teenage survivors of arrhythmic cardiac arrest (Maryniak et al., 2008), and in severe obstructive sleep apnea (Peng et al., 2014). In agreement with the theory of impaired oxygen homeostasis in pathogenesis of self-awareness, also hyperoxygenation may be culpable, for instance in schizophrenia (Powell et al., 2012).

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    It has been suggested that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles (Sauvé et al., 1996). Aphasia, dyskinesias, abnormal motor function, and praxis have also been observed in survivors of arrhythmic cardiac arrest (Maryniak et al., 2008). Many antiarrhythmic drugs that are given to patients with cardiac disease have possible neurologic side-effects (Caplan, 1999b).

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    Some studies excluded survivors with gross neurological impairment,8,9,15 whilst others excluded those that are neurologically intact.16 In some studies specifically identified patient populations were used including teenagers,17 nursing home residents,18 children under the age of 15 years,19 those post-cardiac surgery20 cardiac arrest in the context of acute myocardial infarction21,22 and octogenarians.23 The outcome measures used to assess quality of life and other patient centred outcomes- such as depression, anxiety and cognitive dysfunction were also highly variable (see Table 3 and electronic supplement detailing tools used to assess cognitive function, Table 4).

  • Part 12: Education, implementation, and teams: 2010 International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations

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    Eight prospective cohort studies (LOE P1)622–629, two ‘follow-up of untreated control group in an RCT’ studies (LOE P2)630,631, eight retrospective cohort studies (LOE P3)632–639, and 28 case series (LOE P4)319,326,640–665 showed that quality of life is good in cardiac arrest survivors. One prospective cohort study (LOE P1)666, one ‘follow-up of untreated control group in an RCT’ study (LOE P2)667, three retrospective cohort studies (LOE P3)634,668,669, and 12 case series (LOE P4)417,670–680 showed that cardiac arrest survivors experience problems in physical, cognitive, psychological, and social functioning that impact on quality of life to a varying degree. Seven case series (LOE P4)681–687 suggested that resuscitation led to high rate of cognitive impairment and poorer quality of life.

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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2007.10.024.

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