Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C

Gisela Lilja; Niklas Nielsen; Hans Friberg; Janneke Horn; Jesper Kjaergaard; Fredrik Nilsson; Tommaso Pellis; Jørn Wetterslev; Matt P Wise; Frank Bosch; John Bro-Jeppesen; Iole Brunetti; Azul Forti Buratti; Christian Hassager; Caisa Hofgren; Angelo Insorsi; Michael Kuiper; Alice Martini; Nicki Palmer; Malin Rundgren; Christian Rylander; Annelou van der Veen; Michael Wanscher; Helen Watkins; Tobias Cronberg

doi:10.1161/CIRCULATIONAHA.114.014414

Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33°C versus 36°C

Circulation. 2015 Apr 14;131(15):1340-9. doi: 10.1161/CIRCULATIONAHA.114.014414. Epub 2015 Feb 13.

Authors

Gisela Lilja¹, Niklas Nielsen², Hans Friberg², Janneke Horn², Jesper Kjaergaard², Fredrik Nilsson², Tommaso Pellis², Jørn Wetterslev², Matt P Wise², Frank Bosch², John Bro-Jeppesen², Iole Brunetti², Azul Forti Buratti², Christian Hassager², Caisa Hofgren², Angelo Insorsi², Michael Kuiper², Alice Martini², Nicki Palmer², Malin Rundgren², Christian Rylander², Annelou van der Veen², Michael Wanscher², Helen Watkins², Tobias Cronberg²

Affiliations

¹ From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.). gisela.lilja@med.lu.se.
² From Department of Neurology and Rehabilitation Medicine (G.L., T.C.), Department of Intensive and Perioperative Care (H.F., M.R.), and Research and Development Centre, Unit for Medical Statistics and Epidemiology (F.N.), Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden (G.L., N.N., H.F., M.R., T.C.); Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden (N.N.); Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands (J.H., M.K., A.v.d.V.); Department of Cardiology, The Heart Centre (J.K., J.B.-J., C. Hassager), Copenhagen Trial Unit, Centre for Clinical Intervention Research (J.W.), and Department of Cardiothoracic Anesthesiology, The Heart Centre (M.W.), Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Anaesthesia, Intensive Care, and Emergency Medical Service, Santa Maria degli Angeli Hospital, Pordenone, Italy (T.P., A.M.); Adult Critical Care, University Hospital of Wales, Cardiff, UK (M.P.W., N.P., H.W.); Department of Intensive Care, Rijnstate Hospital, Arnhem, The Netherlands (F.B.); Department of Anaesthesia and Intensive Care, IRCCS San Martino IST, University of Genoa, Italy (I.B., A.I.); Academic Unit of Child and Adolescent Psychiatry, Imperial College, London, UK (A.F.B.); Institute of Neuroscience and Physiology, Section of Clinical Neuroscience and Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Sweden (C. Hofgren); Department of Intensive Care, Medical Center Leeuwarden, The Netherlands (M.K.); and Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden (C.R.).

PMID: 25681466
DOI: 10.1161/CIRCULATIONAHA.114.014414

Abstract

Background: Target temperature management is recommended as a neuroprotective strategy after out-of-hospital cardiac arrest. Potential effects of different target temperatures on cognitive impairment commonly described in survivors have not been investigated sufficiently. The primary aim of this study was to evaluate whether a target temperature of 33°C compared with 36°C was favorable for cognitive function; the secondary aim was to describe cognitive impairment in cardiac arrest survivors in general.

Methods and results: Study sites included 652 cardiac arrest survivors originally randomized and stratified for site to temperature control at 33°C or 36°C within the Target Temperature Management trial. Survival until 180 days after the arrest was 52% (33°C, n=178/328; 36°C, n=164/324). Survivors were invited to a face-to-face follow-up, and 287 cardiac arrest survivors (33°C, n=148/36°C, n=139) were assessed with tests for memory (Rivermead Behavioural Memory Test), executive functions (Frontal Assessment Battery), and attention/mental speed (Symbol Digit Modalities Test). A control group of 119 matched patients hospitalized for acute ST-segment-elevation myocardial infarction without cardiac arrest performed the same assessments. Half of the cardiac arrest survivors had cognitive impairment, which was mostly mild. Cognitive outcome did not differ (P>0.30) between the 2 temperature groups (33°C/36°C). Compared with control subjects with ST-segment-elevation myocardial infarction, attention/mental speed was more affected among cardiac arrest patients, but results for memory and executive functioning were similar.

Conclusions: Cognitive function was comparable in survivors of out-of-hospital cardiac arrest when a temperature of 33°C and 36°C was targeted. Cognitive impairment detected in cardiac arrest survivors was also common in matched control subjects with ST-segment-elevation myocardial infarction not having had a cardiac arrest.

Clinical trial registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01946932.

Keywords: brain; cardiovascular diseases; follow-up studies; heart arrest; myocardial infarction; resuscitation; tests.

Publication types

Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Body Temperature / physiology*
Cognition / physiology*
Electrocardiography
Europe
Female
Follow-Up Studies
Humans
Hypothermia, Induced / methods*
Male
Middle Aged
Myocardial Infarction / physiopathology
Myocardial Infarction / therapy
Out-of-Hospital Cardiac Arrest / physiopathology*
Out-of-Hospital Cardiac Arrest / therapy*
Patient Outcome Assessment
Risk Factors
Treatment Outcome

Associated data

ClinicalTrials.gov/NCT01946932