Abstract 77: CPC 1-2 and Modified Rankin <3 Scoring at Discharge Underestimates the Prevalence and Severity of Cognitive Deficits Seen in Cardiac Arrest Survivors at 3 Months
Background: Cerebral performance category (CPC) and Modified Rankin (MRS) scoring are used commonly to document neurocognitive (NC) function after cardiac arrest (CA) with CPC1-2 or MRS <3 representing "good" neurological outcomes. This non-focused testing may be insensitive for deficits resulting from injury to brain areas most susceptible to global ischemia see in CA.
Hypothesis: CPC 1-2 and MRS <3 at discharge does not adequately identify important NC deficits in survivors of CA.
Methods: One hundred forty-four consecutive CA patients (pts) underwent bundled post arrest care including therapeutic hypothermia (TH) from 2-1-11 through 1-15-13. Fifty-three percent survived to discharge. Three months post discharge, 27 pts underwent a battery of neuropsychological assessments focused on multiple domains known to be sensitive to NC impairment. Reasons for not testing were: unable to perform test due to deficits(17); coma (12); refused (11); no-show (10). Individual pt results were normed for age and education level. Impairment for memory is reported as binomial (impaired vs. not). Impairment in other domains is reported as severely impaired (below the 10th percentile) and mildly impaired (below expectations).
Results: The study population is 24 of the 27 pts who underwent testing at 3 months and were CPC 1-2 and MRS <3 at discharge. Pts were 75% male; mean age 51 (95%CI;45, 57) years; 92% VF; 92% witnessed; 79% bystander CPR; total ischemic time 18.5 (95%CI;17.1, 32.3)min; initial pH 7.19 (95%CI; 7.13, 7.24); initial lactate 8.5 (95%CI; 4.3, 12.6). The most commonly impaired cognitive domains are represented in the table.
Conclusions: NC impairment is common after CA in pts treated with TH and a comprehensive post arrest program. Despite "good" neurologic outcome on traditional measures, CPC and MRS scoring significantly underestimates the prevalence and severity of these deficits at 3 months post discharge.
- © 2013 by American Heart Association, Inc.