Division of Cardiac Prevention and Rehabilitation, University of Ottawa Heart Institute, Ottawa, Canada; School of Psychology, University of Ottawa, Ottawa, Canada.
Clinical Services, University of Ottawa Heart Institute, Ottawa, Canada.
Resuscitation. 2021 Aug;165:154-160. doi: 10.1016/j.resuscitation.2021.05.002. Epub 2021 May 12.
The purpose of this study was to evaluate the rate and domains of cognitive impairment in out-of-hospital cardiac arrest (OHCA) survivors, as compared to patients who experienced a myocardial infarction (MI), and to explore mechanisms and predictors of this impairment.
OHCA survivors with "good" neurological recovery (i.e., Cerebral Performance Categories Scale ≤ 2) (n = 79), as well as a control group of MI patients (n = 69), underwent a comprehensive neuropsychological assessment. Forty-three percent of OHCA survivors were cognitively impaired (in the lowest decile on a global measure of cognitive functioning). Rates of impairment were approximately six times higher in the OHCA group than the MI group. Attention, memory, language and executive function were affected. Downtime was a significant predictor of cognitive impairment; the interaction between downtime and immediate intervention was significant such that, at short downtimes, receiving cardiopulmonary resuscitation (CPR) or defibrillation within 1 min of collapse predicted less cognitive impairment.
OHCA survivors - even those with seemingly good neurological recovery - are at risk for cognitive impairment. Cognitive rehabilitation may be an important consideration post-OHCA.
本研究旨在评估院外心脏骤停 (OHCA) 幸存者与经历心肌梗死 (MI) 的患者相比认知障碍的发生率和领域，并探讨这种障碍的机制和预测因素。
“神经功能良好”恢复（即脑功能分类量表≤2）的 OHCA 幸存者 (n=79) 以及 MI 患者对照组 (n=69) 接受了全面的神经心理学评估。43%的 OHCA 幸存者存在认知障碍（在认知功能整体衡量标准中处于最低十分位数）。OHCA 组的损伤率比 MI 组高约六倍。注意力、记忆、语言和执行功能受到影响。停机时间是认知障碍的一个显著预测因素；停机时间与即刻干预之间的相互作用具有显著性，即停机时间较短时，在心脏骤停后 1 分钟内接受心肺复苏 (CPR) 或除颤预测认知障碍较小。
OHCA 幸存者——即使是那些神经功能似乎良好的幸存者——也存在认知障碍的风险。认知康复可能是 OHCA 后需要考虑的一个重要因素。
