Accepted Manuscript Title: Cognitive Function and Quality of Life after Successful Resuscitation from Cardiac Arrest Author: Stefanie G. Beesems Kim M. Wittebrood Rob J. de Haan Rudolph W. Koster PII: DOI: Reference:
S0300-9572(14)00568-1 http://dx.doi.org/doi:10.1016/j.resuscitation.2014.05.027 RESUS 6020
To appear in:
Resuscitation
Received date: Revised date: Accepted date:
10-2-2014 3-5-2014 23-5-2014
Please cite this article as: Beesems SG, Wittebrood KM, de Haan RJ, Koster RW, Cognitive Function and Quality of Life after Successful Resuscitation from Cardiac Arrest, Resuscitation (2014), http://dx.doi.org/10.1016/j.resuscitation.2014.05.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Cognitive Function and Quality of Life after Successful Resuscitation from Cardiac Arrest
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Stefanie G. Beesems†, MSc, Kim M. Wittebrood†, MSc, Rob J. de Haan‡, PhD, Rudolph W. Koster†, MD, PhD †Department of Cardiology and ‡Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands Short title: Quality of Life after cardiac arrest Address for reprints / corresponding author: Stefanie G. Beesems, MSc
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Department of Cardiology, room G4‐248
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Academic Medical Center – University of Amsterdam
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Meibergdreef 9
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1105 AZ Amsterdam
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The Netherlands
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Tel: +31‐20‐566834
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Fax: +31‐20- 5669131
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Email:
[email protected] 28
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Funding Sources:
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The Arrest data collection is supported by an unconditional grant of Physio‐Control
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Inc, Redmond, WA, USA.
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Word Count: 2979, abstract 258 Figures: 2 Tables: 4
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Abstract
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Background Studies on out‐of‐hospital cardiac arrest (OHCA) use Overall Performance Category
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(OPC)/Cerebral Performance Category (CPC) as outcome. We studied quality of life, neuro‐
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cognitive functioning and independency in daily life of patients and strain of caregivers 6‐12
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months after cardiac arrest.
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Methods 220 patients (>18 year) who survived 6‐12 months after OHCA and relatives were
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interviewed by telephone with validated questionnaires (Short‐form Health Survey) (SF‐12),
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Modified Rankin Scale (MRS), Telephonic Interview Cognitive Status (TICS) and Caregiver Strain
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Index (CSI) and compared with OPC and CPC at discharge. SF‐12 of elderly (≥ 80 years) was
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compared to an open Dutch population of ≥80 years.
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Results Of all patients, 45% had normal physical and 90% had normal mental SF‐12. 81% had a
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normal MRS (MRS≤2). 84% had normal TICS. Compared to the reference population, elderly
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scored 40.5 on the mental and 53.2 on the physical SF‐12, while the reference population scored
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38.1 (θ =0.20) and 54.4 (θ =‐0.15), respectively, (n.s.) Of the patients with OPC≤2 and CPC≤2 at
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discharge 15% scored MRS 3‐5 and 15% abnormal TICS at follow‐up, respectively. 92% of all
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patients gave their quality of life a value of ≥6 (maximum 10). Patients treated with hypothermia
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scored on most health outcomes similar to those who did not need such treatment. 16% of
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caregivers experienced strain, correlating significantly with TICS of patients.
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Conclusion The great majority of survivors have normal functioning and cognition 6‐12 months
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after OHCA. Functional and neuro‐cognitive telephonic tests 6‐12 months after OHCA are simple
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and better reflect patients functioning at home than OPC/CPC at discharge.
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Keywords
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Cardiopulmonary Resuscitation, heart arrest, outcome, quality of life, cognition
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Introduction
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For many years the outcome after resuscitation for out‐of‐hospital cardiac arrest (OHCA) has
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been expressed in overall survival to discharge. This is not considered an adequate expression of
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outcome, as it does not describe the neuro‐cognitive status of the patient. Resuscitation can only
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be considered successful if the survivor has an acceptable quality of life and no impaired
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cognitive function after their resuscitation, now commonly assessed with the Glasgow‐Pittsburg
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Overall Performance Category (OPC) and Cerebral Performance Category (CPC) at the moment
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of discharge.1 Neurologic intact survival (CPC ≤2) is nowadays a core outcome indicator after
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resuscitation of OHCA.2 Even while OPC and CPC scores add a neuro‐functional dimension to the
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outcome, there are drawbacks to this approach. First, the classification is crude with only 2
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dimensions and 5 classes between unimpaired survival and death. Therefore, CPC and OPC may
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not pick up more subtle, but important cognitive damage in the patient. In addition, it is unclear
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if neuro‐cognitive function at discharge is a valid method to assess prognosis and long‐term
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outcome after OHCA. Measurements of neuro‐cognitive function and quality of life preferably
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take place at a time when the patient’s clinical and social condition has stabilized.3 To be suitable
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for use in large cohorts of patients after OHCA, such measurements should be simple, and not
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require time‐consuming face‐to‐face tests.
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The inability of the patient to return to a previous level of function may have a considerable
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impact on the patient’s quality of life. Spouses may also experience dramatic changes in their
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lives when a loved one returns home after a successful resuscitation, but the long‐term impact of
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the event for close family members is rarely considered. 4
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The aim of this study was therefore to (a) assess the neuro‐cognitive function and quality of life
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of patients, in the timeframe 6‐12 months after cardiac arrest, using validated instruments that
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can easily be applied in a telephonic interview, (b) to assess the impact on the caregiver, and (c)
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to investigate the relationship between the patients’ OPC and CPC scores at discharge and their
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level of functional independency and cognitive function at follow‐up. Specific attention was
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given to elderly patients (≥ 80 years of age) and to patients treated with therapeutic
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hypothermia.
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Methods
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Setting
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The AmsteRdam REsuscitation STudy (ARREST) prospectively collects data from all patients
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suffering an OHCA in the province North‐Holland in the Netherlands, since June 2005. Details of
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the design of the data collection in the ARREST study are described elsewhere.5 The data
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collection covers a population of 2.4 million inhabitants. The incidence of EMS treated OHCA
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(with cardiac cause), excluding ambulance witnessed cardiac arrest is 37/100.000
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residents/year. Information is collected from lay rescuers, automatic external defibrillators
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(AED) memory, ambulance personnel, manual defibrillator memory and hospital data up to
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discharge.
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Study design and data collection
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We included all patients in the ARREST study who were resuscitated between April 2010 and
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June 2011 and were discharged alive from hospital. Excluded were patients who died before the
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interview, patients who lived abroad, patients that were not traceable, patients with age