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Abstract

Objective:

We aimed to study the long-term cognitive abilities of patients surviving out-of-hospital cardiac arrest who were treated with therapeutic hypothermia (TH).

Methods:

We prospectively identified and examined consecutive survivors of out-of-hospital cardiac arrest who underwent TH at our institution from June 2006 to May 2011. The results of brain imaging, serum neuron-specific enolase (NSE) measurements, and EEGs were recorded. We assessed cognitive domains using the modified Telephone Interview for Cognitive Status. An education-adjusted score of ≥32 was considered normal.

Results:

Of 133 total patients, 77 (58%) were alive at a median follow-up of 20 months (interquartile range 14-24 months). We interviewed 56 patients (73% of those alive). Median age was 67 years (range 24-88 years). Fifty-one patients (91%) were living independently. Modified Telephone Interview for Cognitive Status scores ranged from 16 to 41. Thirty-three (60%) were considered cognitively normal and 22 (40%) were cognitively impaired. The time to assessment did not differ among the cognitive outcomes (p = 0.557). The median duration of coma was 2 days, possibly indicating that patients with severe anoxic injury were not included. Eighteen patients were not working at the time of their cardiac arrest (17 were retired and 1 was unemployed). Of the 38 patients who were working up to the time of the cardiac arrest, 30 (79%) returned to work. Cognitive outcome was not associated with age, time to return of spontaneous circulation, brain atrophy, or leukoaraiosis.

Conclusions:

The majority of surviving patients who underwent TH after cardiac arrest in this series had preserved cognitive function and were able to return to work.

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Information & Authors

Information

Published In

Neurology®
Volume 81Number 1July 2, 2013
Pages: 40-45
PubMed: 23685933

Publication History

Received: October 2, 2012
Accepted: March 14, 2013
Published online: May 17, 2013
Published in print: July 2, 2013

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Disclosure

J.E. Fugate serves as a member of the Resident & Fellow Section Editorial Team for Neurology®, S.A. Moore reports no disclosures. D.S. Knopman serves as Deputy Editor for Neurology®; served on a Data Safety Monitoring Board for Lilly Pharmaceuticals; served as a consultant to TauRx, and was an investigator in clinical trials sponsored by Baxter, Elan Pharmaceuticals, and Forest Pharmaceuticals; and receives research support from the NIH. D.O. Claassen, E.F.M. Wijdicks, and R.D. White report no disclosures. A.A. Rabinstein serves as a member of the Editorial Board for Neurology®. Go to Neurology.org for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Jennifer E. Fugate, DO
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
1) NEUROLOGY Resident & Fellow Section - previously was a member of this editorial section (2009-2012)
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Samuel A. Moore, MD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
David S. Knopman, MD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
Lilly Pharmaceuticals, Data Safety Monitoring Board, ended 8/22/12; TauRx consultant 2012; Consultant, McGill University Alzheimer Program 9/19/12; Consultant Bluefield project (frontotemporal demantia) 2013
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Lecture, University of Toronto, March 2012 (2) Lecture, University of Pennsylvania, January 2013
Editorial Boards:
1.
Neurology, Deputy Editor
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
(1) Janssen Alzheimer Immunotherapy program 3/29/11: honorarium paid to my institution; (2) Merck Alzheimer program 11/5/11 paid to my institution. (3) TauRx: two presentations in clinical trial investigator meetings.
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
(1) Janssen for Alzheimer clinical trial, (2) Forest Laboratories for clinical trial in FTLD with memantine, (3) Baxter Laboratories for Alzheimer Clinical trial
Research Support, Government Entities:
1.
NIH: R01-AG11378 ongoing, P50-AG 16574 (Mayo Alzheimer's Disease Research Center) ongoing, U01 AG 06786 (Mayo Alzheimer Disease Patient Registry) ongoing. NIH R01 AG32306 FTD Neuro-imaging;Initiative. 1U01HL096917-01 ARIC Dementia Study.AG 037551 Chronic Kidney Disease and Cognitive functioning.
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Daniel O. Claassen, MD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Teva Pharmaceuticals, speaker honoraria
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
American Academy of Neurology, Clinical Research Fellowship. 2009-2011
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Eelco F.M. Wijdicks, MD, PhD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editor-in-Chief, Neurocritical Care, 2004-2012
Patents:
1.
NONE
Publishing Royalties:
1.
Books published by Oxford University Press
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Roger D. White, MD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
Alejandro A. Rabinstein, MD
From the Departments of Neurology (J.E.F., S.A.M., D.S.K., E.F.M.W., A.A.R.), Internal Medicine, and Anesthesiology, Division of Cardiovascular Diseases (R.D.W.), Mayo Clinic, Rochester, MN; and Department of Neurology (D.O.C.), Vanderbilt University Medical Center, Nashville, TN.
Disclosure
Scientific Advisory Boards:
1.
Safety monitoring board for ALIAS and PREVAIL trials
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
NONE
Editorial Boards:
1.
Editorial Board member - Neurology Associate editor - Neurocritical Care
Patents:
1.
NONE
Publishing Royalties:
1.
Practical Neuroimaging in Stroke - Elsevier - 2009 What To Do? Neurocritical Care - Oxford - 2011
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
NONE
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
Principal Investigator - Unrestricted research grant from CardioNet for an investigator-initiated project (2009-2011) Principal Investigator - Unrestricted research grant from DJO Global for an investigator-initiated project (2013-present)
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence to Dr. Rabinstein: [email protected]
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

Author Contributions

Dr. Fugate: drafting/revising the manuscript, acquisition of data, statistical analysis, analysis or interpretation of data. Dr. Moore: drafting/revising the manuscript, acquisition of data. Dr. Knopman: drafting/revising the manuscript, analysis or interpretation of data, study supervision. Dr. Claassen: study concept or design, drafting/revising the manuscript, acquisition of data. Dr. Wijdicks: drafting/revising the manuscript, analysis or interpretation of data, study supervision. Dr. White: drafting/revising the manuscript, study supervision. Dr. Rabinstein: study concept or design, drafting/revising the manuscript, analysis or interpretation of data, study supervision.

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