Abstract 105: Cognitive Deficits at Discharge in Cardiac Arrest Survivors Treated With Therapeutic Hypothermia: Is "Good" as Good as We Think?
Background: Cognitive deficits may be missed by CPC and Modified Rankin scoring done at discharge (DC) after cardiac arrest (CA). Cognitive dysfunction is common after brain injury and may lead to significant morbidity in post arrest patients (pts). The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) norms its results to the general population and is validated to detect cognitive impairment in a variety of neurocognitive disorders.
Hypothesis: CA survivors treated with therapeutic hypothermia (TH) will have more cognitive deficits identified by RBANS testing at DC than the normative population.
Methods: Three hundred six consecutive pts treated with TH in a comprehensive post arrest program between 10-1-08 and 4-30-13 were included. Survival was 51%. Of the 155 survivors, 60 (39%) were tested with RBANS within 2 days of DC. Reasons for not testing: 59 (38%) could not perform test due to readily identifiable neurocognitive deficits; 21 (13%) DC prior to testing; 15 (10%) refused to perform test. RBANS testing is administered over approximately 30 minutes and measures attention, visuospatial/constructional ability, and immediate and delayed memory. Results are presented as mean ± 95% CI. One-sample t-tests were conducted to compare the 5 RBANS domain scores and the total score to the normative average which is 100.
Results: The study population was 78% male; 95% witnessed; 85% VF. Ninety-seven percent of pts tested were CPC 1-2 and all were MRS <3 at DC. Results are shown in the table.
Conclusion: Significant neurocognitive impairment, especially in memory, is seen at DC in CA pts treated with TH, even in those who are deemed to have "good" neurological outcomes by CPC or MRS scoring. Consideration should be given to performing a more detailed neurocognitive assessment in pts prior to DC so that appropriate treatment and follow up can be given. More detailed cognitive scoring at DC may be helpful in evaluating outcome after CA interventions.
- © 2013 by American Heart Association, Inc.