Department of Psychiatry and Behavioral Sciences, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Appl Neuropsychol Adult. 2023;30(5):614-621. doi: 10.1080/23279095.2021.2004145. Epub 2021 Nov 19.
Time is critical with any out of hospital cardiac arrest (OHCA). The possibility of brain cell death increases, and the likelihood of a "good" outcome decreases with time. The most prominent impairments involve memory and attentional difficulties. Limited research and few cases have shown positive cognitive results following an OHCA to the extent that this case study depicts.
The current case study presents a right-handed male in his late 40s, with master's and law degrees, and a high-level functioning in the workplace who experienced an OHCA. He was treated for his OHCA and subsequently underwent neuropsychological testing less than 2 months following his hospital discharge.
Expected results suggest impairments in key cognitive areas; however, a neuropsychological exam less than 2-months post-incident, testing pre-morbid IQ, overall cognitive ability, processing speed, attention, executive functioning, language, visuospatial abilities, and memory; each showing normal or better results. Additionally, self and collateral report questionnaires examining cognitive and emotional functioning reported no difficulties and no major changes since his cardiac arrest.
We speculate that this patient's exceptional outcome might be due to his cognitive reserve, and the immediateness of his intervention (5-10 min of CPR and return-of-spontaneous-circulation from an AED shock) and use of a saline cooling procedure upon arrival to the hospital. Overall, we highlight a patient with a remarkable cognitive outcome, utilizing data from neuropsychological testing within 2-months post-incident, and propose protective factors in neuropsychological functioning following an OHCA.
任何院外心脏骤停（OHCA）都很紧迫。随着时间的推移，脑细胞死亡的可能性增加，“良好”结果的可能性降低。最突出的损伤涉及记忆和注意力困难。有限的研究和少数病例表明，OHCA 后认知结果呈阳性，达到了本案例研究所描绘的程度。
本案例研究介绍了一位 40 多岁的右利手男性，拥有硕士和法律学位，在工作场所表现出高水平的功能，经历了 OHCA。他接受了 OHCA 的治疗，随后在出院后不到 2 个月接受了神经心理学测试。
预期结果表明在关键认知领域存在损伤；然而，在事件发生后不到 2 个月进行的神经心理学检查，测试了术前智商、整体认知能力、处理速度、注意力、执行功能、语言、视空间能力和记忆；每项测试结果均为正常或更好。此外，自我和旁证报告问卷检查认知和情绪功能，报告没有困难，也没有自心脏骤停以来发生重大变化。
我们推测，该患者的出色结果可能归因于他的认知储备，以及干预的及时性（CPR 持续 5-10 分钟，从 AED 电击中恢复自主循环），以及在到达医院后使用盐水冷却程序。总体而言，我们强调了一位患者具有显著的认知结果，利用了事件发生后 2 个月内的神经心理学测试数据，并提出了 OHCA 后神经心理学功能的保护因素。
