心脏骤停后的神经心理学结果：来自院外心脏骤停后目标低温与目标正常体温（TTM2）试验的子研究结果。
Neuropsychological outcome after cardiac arrest: results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial.
机构信息
Neurology, Department of Clinical Sciences Lund, Skane University Hospital, Lund University, Lund, Sweden.
Department of Psychology, Lund University, Lund, Sweden.
出版信息
Crit Care. 2023 Aug 26;27(1):328. doi: 10.1186/s13054-023-04617-0.
BACKGROUND
Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.
METHODS
This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes.
RESULTS
Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance.
CONCLUSIONS
In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.
TRIAL REGISTRATION
ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
背景
院外心脏骤停（OHCA）后常发生认知障碍，但对其性质了解甚少。我们的目的是描述 OHCA 幸存者的认知障碍，并假设 OHCA 幸存者在神经心理学认知测试中的表现明显差于急性心肌梗死（MI）的对照组。另一个目的是研究认知表现与 OHCA 后与情绪问题、疲劳、失眠和心血管危险因素相关的因素之间的关系。
方法
这是一项针对瑞典、丹麦和英国的目标低温与目标常温治疗院外心脏骤停后（TTM2）试验的前瞻性病例对照子研究。来自 TTM2 试验的 61 个地点中有 8 个地点纳入了 OHCA 幸存者，其病因被认为是心脏性或不明原因。招募了急性 MI 的匹配非发作对照组。大约在事件发生后 7 个月，我们进行了广泛的神经心理学测试和焦虑、抑郁、疲劳和失眠的问卷调查，并收集了高血压和糖尿病等心血管危险因素的信息。
结果
在 184 名符合条件的 OHCA 幸存者中，有 108 名入选，其中 92 名 MI 对照组入选。在 OHCA 幸存者中，29%的人在至少 2 个认知领域的 z 评分≤-1（至少有边缘轻度损伤），14%的人在至少 1 个认知领域的 z 评分≤-2（主要损伤），而 54%的人在任何领域都没有损伤。认知障碍在情景记忆、执行功能和处理速度方面最为明显。OHCA 幸存者在情景记忆（平均差异 MD=-0.37，95%置信区间 [-0.61，-0.12]）、言语（MD=-0.34 [-0.62，-0.07]）和视觉/建构功能（MD=-0.26 [-0.47，-0.04]）上的表现明显差于 MI 对照组，这些差异在调整了教育程度和性别后仍存在线性回归。当进一步调整焦虑、抑郁、疲劳、失眠、高血压和糖尿病时，执行功能（MD=-0.44 [-0.82，-0.06]）在 OHCA 后也更差。糖尿病、焦虑、抑郁和疲劳症状与认知表现较差显著相关。
结论
在我们的研究人群中，OHCA 后认知障碍一般较为轻微。OHCA 幸存者在 6 个领域中的 3 个领域的表现明显差于 MI 对照组。这些结果支持当前的指南，即 OHCA 后随访服务应筛查认知障碍、情绪问题和疲劳。
试验注册
ClinicalTrials.gov，NCT03543371。2018 年 6 月 1 日注册。
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