Predicting Long-Term Cognitive Impairments in Survivors after Cardiac Arrest: A Systematic Review
DOI:
https://doi.org/10.2340/jrm.v55.3497Keywords:
prediction, long-term cognitive outcome, cardiac arrest survivorsAbstract
Objective: International guidelines recommend early screening for identification of patients who are at risk of long-term cognitive impairments after cardiac arrest. However, information about predictors is not provided. A systematic review of the literature was performed to identify early predictors of long-term cognitive outcome after cardiac arrest.
Methods: Scopus and PubMed were systematically searched to identify studies on early predictors of long-term cognitive outcome in patients after cardiac arrest. The population included adult cardiac arrest survivors and potential early predictors were demographics, early cognitive screening scores, imaging measures, electroencephalographic measures, and levels of blood biomarkers. Two investigators reviewed studies for relevance, extracted data and assessed risk of bias.
Results: Five articles were included. Risk of bias was assessed as low or moderate. Most detected longterm cognitive impairments were in the domain of memory. Coma duration (2 studies), early cognitive impairments by the self-developed clinical Bedside Neuropsychological Test Battery (BNTB) screener (2 studies), and high S-100B levels on day 3 (2 studies) were the most prominent identified determinants of cognitive impairment on the group level. On the individual patient level, a score on the BNTB of ≤ 94.5 predicted cognitive impairments at 6 months after cardiac arrest (1 study without external validation). Studies on brain imaging and electroencephalography are lacking.
Conclusion: Early bedside cognitive screening can contribute to prediction of long-term cognitive impairment after cardiac arrest. Evidence is scarce for S-100B levels and coma duration and absent for measures derived from brain imaging and electroencephalography.
LAY ABSTRACT
Survival rates of patients after cardiac arrest have increased significantly over the past decades. However, many cardiac arrest survivors have impairments in different domains of thinking (memory, attention, and executive functions, such as planning). Early identification of survivors at risk of such impairments could guide personalized rehabilitation. However, such predictors are currently unavailable. This study reviewed the literature to identify possible early predictors for patients at risk of long-term impairments in thinking. A short, early, bedside test to screen domains of thinking during hospital admission may help to predict long-term impairments. Certain blood markers and a long duration of coma have also been associated with long-term impairments of thinking, but the evidence is weak. There are no studies on brain imaging and electroencephalography in this context.
Downloads
References
Husain S, Eisenberg M. Police AED programs: a systematic review and meta-analysis. Resuscitation 2013; 84: 1184-1191.
https://doi.org/10.1016/j.resuscitation.2013.03.040 DOI: https://doi.org/10.1016/j.resuscitation.2013.03.040
Zijlstra JA, Radstok A, Pijls R, Nas J, Beesems SG, Hulleman M, et al. Hoofdstuk 1. Overleving na een reanimatie buiten het ziekenhuis: vergelijking van de resultaten van 6 verschillende Nederlandse regio's [Chapter 1: Survival after CPR outside the hospital: comparison of the results of 6 different Dutch regions]. In: Reanimatie in Nederland [Resuscitation in the Netherlands]. Den Haag: Hartstichting, 2016.
Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, et al. Long-term survival after out-of-hospital cardiac arrest: a systematic review and meta-analysis. JAMA Cardiol 2022; 7: 633-643.
https://doi.org/10.1001/jamacardio.2022.0795 DOI: https://doi.org/10.1001/jamacardio.2022.0795
Green CR, Botha JA, Tiruvoipati R. Cognitive function, quality of life and mental health in survivors of out-of-hospital cardiac arrest: a review. Anaesth Intensive Care 2015; 43: 568-576.
https://doi.org/10.1177/0310057X1504300504 DOI: https://doi.org/10.1177/0310057X1504300504
Moulaert VR, Verbunt JA, van Heugten CM, Wade DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation 2009; 80: 297-305.
https://doi.org/10.1016/j.resuscitation.2008.10.034 DOI: https://doi.org/10.1016/j.resuscitation.2008.10.034
Glimmerveen AB, Ruijter BJ, Keijzer HM, Tjepkema-Cloostermans MC, van Putten M, Hofmeijer J. Association between somatosensory evoked potentials and EEG in comatose patients after cardiac arrest. Clin Neurophysiol 2019; 130: 2026-2031.
https://doi.org/10.1016/j.clinph.2019.08.022 DOI: https://doi.org/10.1016/j.clinph.2019.08.022
Nolan JP, Sandroni C, Bottiger BW, Cariou A, Cronberg T, Friberg H, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: Post-resuscitation care. Resuscitation 2021; 161: 220-269.
https://doi.org/10.1016/j.resuscitation.2021.02.012 DOI: https://doi.org/10.1016/j.resuscitation.2021.02.012
Wachelder EM, Moulaert VR, van Heugten C, Verbunt JA, Bekkers SC, Wade DT. Life after survival: long-term daily functioning and quality of life after an out-of-hospital cardiac arrest. Resuscitation 2009; 80: 517-522.
https://doi.org/10.1016/j.resuscitation.2009.01.020 DOI: https://doi.org/10.1016/j.resuscitation.2009.01.020
Moulaert VR, Wachelder EM, Verbunt JA, Wade DT, van Heugten CM. Determinants of quality of life in survivors of cardiac arrest. J Rehabil Med 2010; 42: 553-558.
https://doi.org/10.2340/16501977-0547 DOI: https://doi.org/10.2340/16501977-0547
van Gils P, van Heugten C, Hofmeijer J, Keijzer H, Nutma S, Duits A. The Montreal Cognitive Assessment is a valid cognitive screening tool for cardiac arrest survivors. Resuscitation 2022; 172: 130-136.
https://doi.org/10.1016/j.resuscitation.2021.12.024 DOI: https://doi.org/10.1016/j.resuscitation.2021.12.024
Mourad Ouzzani, Hossam Hammady, Zbys Fedorowicz, Ahmed Elmagarmid. Rayyan - a web and mobile app for systematic reviews. Systematic Reviews (2016) 5:210, DOI:10.1186/s13643-016-0384-4
https://doi.org/10.1186/s13643-016-0384-4 DOI: https://doi.org/10.1186/s13643-016-0384-4
Hayden JA, van der Windt DA, Cartwright JL, Cote P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013; 158: 280-286.
https://doi.org/10.7326/0003-4819-158-4-201302190-00009 DOI: https://doi.org/10.7326/0003-4819-158-4-201302190-00009
Prohl J, Bodenburg S, Rustenbach SJ. Early prediction of long-term cognitive impairment after cardiac arrest. J Int Neuropsychol Soc 2009; 15: 344-353.
https://doi.org/10.1017/S1355617709090493 DOI: https://doi.org/10.1017/S1355617709090493
Prohl J, Röther J, Kluge S, de Heer G, Liepert J, Bodenburg S, et al. Prediction of short-term and long-term outcomes after cardiac arrest: a prospective multivariate approach combining biochemical, clinical, electrophysiological, and neuropsychological investigations. Crit Care Med 2007; 35: 1230-1237.
https://doi.org/10.1097/01.CCM.0000261892.10559.85 DOI: https://doi.org/10.1097/01.CCM.0000261892.10559.85
Sauve MJ, Doolittle N, Walker JA, Paul SM, Scheinman MM. Factors associated with cognitive recovery after cardiopulmonary resuscitation. Am J Crit Care 1996; 5: 127-139.
https://doi.org/10.4037/ajcc1996.5.2.127 DOI: https://doi.org/10.4037/ajcc1996.5.2.127
Sauve MJ, Walker JA, Massa SM, Winkle RA, Scheinman MM. Patterns of cognitive recovery in sudden cardiac arrest survivors: the pilot study. Heart Lung 1996; 25: 172-181.
https://doi.org/10.1016/S0147-9563(96)80027-6 DOI: https://doi.org/10.1016/S0147-9563(96)80027-6
Ørbo M, Aslaksen PM, Larsby K, Norli L, Schäfer C, Tande PM, et al. Determinants of cognitive outcome in survivors of out-of-hospital cardiac arrest. Resuscitation 2014; 85: 1462-1468.
https://doi.org/10.1016/j.resuscitation.2014.08.010 DOI: https://doi.org/10.1016/j.resuscitation.2014.08.010
Cronberg T, Greer DM, Lilja G, Moulaert V, Swindell P, Rossetti AO. Brain injury after cardiac arrest: from prognostication of comatose patients to rehabilitation. Lancet Neurology 2020; 19: 611-622.
https://doi.org/10.1016/S1474-4422(20)30117-4 DOI: https://doi.org/10.1016/S1474-4422(20)30117-4
Ruijter BJ, Tjepkema-Cloostermans MC, Tromp SC, van den Bergh WM, Foudraine NA, Kornips FHM, et al. Early electroencephalography for outcome prediction of postanoxic coma: a prospective cohort study. Ann Neurol 2019; 86: 203-214.
https://doi.org/10.1002/ana.25518 DOI: https://doi.org/10.1002/ana.25518
Hirsch KG, Fischbein N, Mlynash M, Kemp S, Bammer R, Eyngorn I, et al. Prognostic value of diffusion-weighted MRI for post-cardiac arrest coma. Neurology 2020; 94: e1684-e1692.
https://doi.org/10.1212/WNL.0000000000009289 DOI: https://doi.org/10.1212/WNL.0000000000009289
Salvadori E, Cova I, Mele F, Pomati S, Pantoni L. Prediction of post-stroke cognitive impairment by Montreal Cognitive Assessment (MoCA) performances in acute stroke: comparison of three normative datasets. Aging Clin Exp Res 2022; 34: 1855-1863.
https://doi.org/10.1007/s40520-022-02133-9 DOI: https://doi.org/10.1007/s40520-022-02133-9
Keser Z, Buchl SC, Seven NA, Markota M, Clark HM, Jones DT, et al. Electroencephalogram (EEG) with or without transcranial magnetic stimulation (TMS) as biomarkers for post-stroke recovery: a narrative review. Front Neurol 2022; 13: 827866.
https://doi.org/10.3389/fneur.2022.827866 DOI: https://doi.org/10.3389/fneur.2022.827866
Doerrfuss JI, Kilic T, Ahmadi M, Holtkamp M, Weber JE. Quantitative and qualitative EEG as a prediction tool for outcome and complications in acute stroke patients. Clin EEG Neurosci 2020; 51: 121-129.
https://doi.org/10.1177/1550059419875916 DOI: https://doi.org/10.1177/1550059419875916
Selnes P, Grambaite R, Rincon M, Bjornerud A, Gjerstad L, Hessen E, et al. Hippocampal complex atrophy in poststroke and mild cognitive impairment. J Cereb Blood Flow Metab 2015; 35: 1729-1737.
https://doi.org/10.1038/jcbfm.2015.110 DOI: https://doi.org/10.1038/jcbfm.2015.110
McGuinness LA, Higgins JPT. Risk-of-bias VISualization (robvis): an R package and Shiny web app for visualizing risk-of-bias assessments. Res Synth Methods 2021; 12: 55-61.
https://doi.org/10.1002/jrsm.1411 DOI: https://doi.org/10.1002/jrsm.1411
Additional Files
Published
How to Cite
License
Copyright (c) 2023 Astrid Glimmerveen, Marlous Verhulst, Jeanine Verbunt, Caroline van Heugten, Jeannette Hofmeijer
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All digitalized JRM contents is available freely online. The Foundation for Rehabilitation Medicine owns the copyright for all material published until volume 40 (2008), as from volume 41 (2009) authors retain copyright to their work and as from volume 49 (2017) the journal has been published Open Access, under CC-BY-NC licences (unless otherwise specified). The CC-BY-NC licenses allow third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for non-commercial purposes, provided proper attribution to the original work.
From 2024, articles are published under the CC-BY licence. This license permits sharing, adapting, and using the material for any purpose, including commercial use, with the condition of providing full attribution to the original publication.
