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January 13, 1993, Vol 269, No. 2 >
ARTICLE | January 13, 1993

Neuropsychological Sequelae of Cardiac Arrest FREE

Risto O. Roine, MD; Soili Kajaste, MSc; Markku Kaste, MD
[+] Author Affiliations

Reprint requests to Department of Neurology, University of Helsinki, SF-00290 Helsinki, Finland (Dr Roine).


JAMA. 1993;269(2):237-242. doi:10.1001/jama.1993.03500020071034
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Published online
Article
References

Objectives.  —Prospective and community-based studies on the cognitive outcome of out-of-hospital cardiac arrest have not been published. We studied prospectively the neuropsychological sequelae of cardiac arrest and evaluated the effects of nimodipine on them.

Design.  —Placebo-controlled, randomized, double-blind trial of nimodipine compared with placebo in out-of-hospital ventricular fibrillation.

Setting.  —Urban area of 500 000 inhabitants served by the physician-manned Advanced Life Support Unit of Helsinki.

Patients.  —A total of 155 successfully resuscitated consecutive patients out of 677 resuscitation attempts during 2½ years. Sixty-eight survivors were examined by a neuropsychologist and a neurologist.

Main Outcome Measure.  —Neuropsychological outcome 3 months and 1 year after cardiac arrest.

Interventions.  —Nimodipine or placebo at a dosage of 10 γ/kg as an intravenous injection immediately after restoration of spontaneous circulation, followed by an infusion of 0.5 γg/kg per minute for 24 hours.

Results.  —Three months after cardiac arrest, 41 (61%) of 68 patients were found to have moderate to severe cognitive deficits. At 12 months, 26 (48%) of 54 survivors still had moderate to severe deficits, and the Symptom Check List 90—Revised score indicated the presence of depression in 22 patients (45%) and severe depression in 12 patients (24%).

Conclusions.  —Moderate to severe neuropsychological sequelae of out-of-hospital cardiac arrest are still present in approximately one half of the survivors at 1 year and may be permanent. There seems to be no excess of increased disability in the subgroup of patients with delayed advanced life support. Nimodipine failed to show any effect on the cognitive functions tested.(JAMA. 1993;269:237-242)

REFERENCES

1 +
Sotaniemi KA, Juolasmaa A, Hokkanen ET.  Neuropsychologic outcome after open-heart surgery. Arch Neurol . 1981;;38:2-8.
2 +
Kornfeld DS, Heller SS, Frank KA, Wilson SN, Malm JR.  Psychological and behavioral responses after coronary artery bypass surgery. Circulation . 1982;;66:24-28.
3 +
Jenkins CD, Stanton BA, Savageau JA, Denlinger P, Klein MD.  Coronary artery bypass surgery: physical, psychological, social and economic outcomes 6 months later. JAMA . 1983;;250:782-788.
4 +
Nussmeier NA, Arlund C, Slogoff S.  Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology . 1986;;64:165-170.
5 +
Magni G, Unger HP, Valfre C, et al.  Psychosocial outcome 1 year after heart surgery: a prospective study. Arch Intern Med . 1987;;147:473-477.
6 +
Shaw PJ, Bates D, Cartlidge NEF, et al.  Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke . 1987;; 18:700-707.
7 +
Bengtsson M, Holmberg S, Jansson B.  A psychiatric-psychological investigation of patients who had survived circulatory arrest. Acta Psychiatr Scand . 1969;;45:327-346.
8 +
Willanger R, Klee A, Lindenberg O, Jörgensen EO.  A neuro-psychological study of cerebral anoxic sequelae of cardiac arrest. Acta Neurol Scand . 1970;; 46( (suppl 43) ):103-104.
9 +
Yarnell PR.  Neurological outcome of prolonged coma survivors of out-of-hospital cardiac arrest. Stroke . 1976;;7:279-282.
10 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-575.
11 +
Volpe BT, Hirst W.  The characterization of an amnesic syndrome following hypoxic ischemic injury. Arch Neurol . 1983;;40:436-440.
12 +
Kotila M, Kajaste S.  Neurological and neuropsychological symptoms after cardiac arrest. Acta Neurol Scand . 1984;;69( (suppl 98) ):337-338.
13 +
Volpe BT, Holtzman JD, Hirst W.  Further characterization of patients with amnesia after cardiac arrest preserved recognition memory. Neurology . 1986;;36:408-411.
14 +
Volpe BT, Petito CK.  Dementia with bilateral medial temporal lobe ischemia. Neurology . 1985;; 35:1793-1797.
15 +
Petito CK, Feldmann E, Pulsinelli WA, Plum F.  Delayed hippocampal damage in humans following cardiorespiratory arrest. Neurology . 1987;;37: 1281-1286.
16 +
Bertini G, Giglioli C, Giovannini F, et al.  Neuropsychological outcome of survivors of out-of-hospital cardiac arrest. J Emerg Med . 1990;;8:407-412.
17 +
Caronna JJ, Finklestein S.  Neurological syndromes after cardiac arrest. Stroke . 1978;;9:517-520.
18 +
Cummings JL, Tomiyasu U, Read S, Benson F.  Amnesia with hippocampal lesions after cardiopulmonary arrest. Neurology . 1984;;34:679-681.
19 +
Zola-Morgan S, Squire LR, Amaral DG.  Human amnesia and the medial temporal region enduring memory impairment following a bilateral lesion limited to field cardiac arrest1 of the hippocampus. J Neurosci . 1986;;6:2950-2967.
20 +
Druhe CM, Hartje W.  Hypoxic amnesia following heart arrest: a neuropsychological case study. Nervenarzt . 1989;;60:280-283.
21 +
Newman S, Pugsley W, Klinger L, Harrison M, Aveling W, Treasure T.  Neuropsychological consequences of circulatory arrest with hypothermia: a case report. J Clin Exp Neuropsychol . 1989;;11: 529-538.
22 +
Laplane D, Levasseur M, Pillon B, et al.  Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions: a neuropsychological, magnetic resonance imaging and positron tomography study. Brain . 1989;;112:699-725.
23 +
Pickard JD, Murray GD, Illingworth R, et al.  Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage: British aneurysm nimodipine trial. BMJ . 1989;;298:636-642.
24 +
Roine RO, Kaste M, Kinnunen A, Nikki P, Sarna S, Kajaste S.  Nimodipine after resuscitation from out-of-hospital ventricular fibrillation: a placebo-controlled, double-blind, randomized trial. JAMA . 1990;;264:3171-3177.
25 +
Folstein MF, Folstein SE, McHugh PR.  'Mini-Mental State': a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res . 1975;;12:189-198.
26 +
Wechsler D. Manual for the Wechsler Adult Intelligence Scale . New York, NY: Psychological Corp; 1955;.
27 +
Wechsler D.  A standardized memory scale for clinical use. J Psychol . 1945;;19:87-95.
28 +
Lezak MD. Neuropsychological Assessment . New York, NY: Oxford University Press; 1983;.
29 +
Benton AL, Eslinger PJ, Damasio AR.  Normative observations on neuropsychological test performance in old age. J Clin Neuropsychol . 1981;;3: 33-42.
30 +
Christensen A-L. Luria's Neuropsychological Investigation, Text, Manual, Cards . Copenhagen, Denmark: Munksgaard; 1975;.
31 +
Luria AR. The Working Brain . Harmondsworth, England: Penguin Books Ltd; 1973;.
32 +
Radloff LS.  The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas . 1977;;1:385-401.
33 +
Weissmann MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ.  Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol . 1977;;106:203-214.
34 +
Shinar D, Gross CR, Price TR, Banko M, Bolduc PL, Robinson RG.  Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiological Studies Depression Scale. Stroke . 1986;;17:241-245.
35 +
Derogatis LR. SCL-90-R. Administration, Scoring and Procedures Manual—II . 2nd ed. Towson, Md: Clinical Psychometric Research; 1983;.
36 +
Armitage P, Berry G. Statistical Methods in Medical Research . Oxford, England: Blackwell Scientific Publications; 1987;.
37 +
Dixon WJ, Brown MB, Engelman L, Hill MA, Jennrich RI. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;: 1, 2.
38 +
Abikoff H, Alvir J, Hong G.  Logical memory subtest of the Wechsler Memory Scale: age and education norms and alternate-form reliability of two scoring systems. J Clin Exp Neuropsychol . 1987;;9:435-448.
39 +
Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR.  Prehospital ventricular fibrillation: prognosis and follow-up course. N Engl J Med . 1974;; 291:317-321.
40 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health . 1985;;75:1321-1323.
41 +
Forsman M, Olsnes BT, Semb G, Steen PA.  Effects of nimodipine on cerebral blood flow and neuropsychological outcome after cardiac surgery. Br J Anaesth . 1990;;65:514-520.
42 +
Säveland H, Sonesson B, Ljunggren B, Ryman T, Brandt L.  Does intravenous nimodipine treatment influence cognition in patients subjected to early aneurysm operation? Acta Neurol Scand . 1988;; 77:54-59.
43 +
Rome RO, Launes J, Nikkinen P, Lindroth L, Kaste M.  Regional CBF after human cardiac arrest: HM-PAO SPECT study. Arch Neurol . 1991;; 48:625-629.
44 +
Flynn JR.  The mean IQ of Americans: massive gains 1932 to 1978. Psychol Bull . 1984;;95:29-51.
45 +
Larrabee GJ.  Further cautions in interpretation of comparison between the WAIS-R and the Wechsler Memory score. J Clin Exp Neuropsychol . 1987;;9:456-460.
46 +
Botwinick J.  Neuropsychology of aging . In: Filskov SB, Boll TJ, eds. Handbook of Clinical Neuropsychology . New York, NY: John Wiley & Sons Inc; 1981;:135-171.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Sotaniemi KA, Juolasmaa A, Hokkanen ET.  Neuropsychologic outcome after open-heart surgery. Arch Neurol . 1981;;38:2-8.
2 +
Kornfeld DS, Heller SS, Frank KA, Wilson SN, Malm JR.  Psychological and behavioral responses after coronary artery bypass surgery. Circulation . 1982;;66:24-28.
3 +
Jenkins CD, Stanton BA, Savageau JA, Denlinger P, Klein MD.  Coronary artery bypass surgery: physical, psychological, social and economic outcomes 6 months later. JAMA . 1983;;250:782-788.
4 +
Nussmeier NA, Arlund C, Slogoff S.  Neuropsychiatric complications after cardiopulmonary bypass: cerebral protection by a barbiturate. Anesthesiology . 1986;;64:165-170.
5 +
Magni G, Unger HP, Valfre C, et al.  Psychosocial outcome 1 year after heart surgery: a prospective study. Arch Intern Med . 1987;;147:473-477.
6 +
Shaw PJ, Bates D, Cartlidge NEF, et al.  Neurologic and neuropsychological morbidity following major surgery: comparison of coronary artery bypass and peripheral vascular surgery. Stroke . 1987;; 18:700-707.
7 +
Bengtsson M, Holmberg S, Jansson B.  A psychiatric-psychological investigation of patients who had survived circulatory arrest. Acta Psychiatr Scand . 1969;;45:327-346.
8 +
Willanger R, Klee A, Lindenberg O, Jörgensen EO.  A neuro-psychological study of cerebral anoxic sequelae of cardiac arrest. Acta Neurol Scand . 1970;; 46( (suppl 43) ):103-104.
9 +
Yarnell PR.  Neurological outcome of prolonged coma survivors of out-of-hospital cardiac arrest. Stroke . 1976;;7:279-282.
10 +
Bedell SE, Delbanco TL, Cook EF, Epstein FH.  Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med . 1983;;309:569-575.
11 +
Volpe BT, Hirst W.  The characterization of an amnesic syndrome following hypoxic ischemic injury. Arch Neurol . 1983;;40:436-440.
12 +
Kotila M, Kajaste S.  Neurological and neuropsychological symptoms after cardiac arrest. Acta Neurol Scand . 1984;;69( (suppl 98) ):337-338.
13 +
Volpe BT, Holtzman JD, Hirst W.  Further characterization of patients with amnesia after cardiac arrest preserved recognition memory. Neurology . 1986;;36:408-411.
14 +
Volpe BT, Petito CK.  Dementia with bilateral medial temporal lobe ischemia. Neurology . 1985;; 35:1793-1797.
15 +
Petito CK, Feldmann E, Pulsinelli WA, Plum F.  Delayed hippocampal damage in humans following cardiorespiratory arrest. Neurology . 1987;;37: 1281-1286.
16 +
Bertini G, Giglioli C, Giovannini F, et al.  Neuropsychological outcome of survivors of out-of-hospital cardiac arrest. J Emerg Med . 1990;;8:407-412.
17 +
Caronna JJ, Finklestein S.  Neurological syndromes after cardiac arrest. Stroke . 1978;;9:517-520.
18 +
Cummings JL, Tomiyasu U, Read S, Benson F.  Amnesia with hippocampal lesions after cardiopulmonary arrest. Neurology . 1984;;34:679-681.
19 +
Zola-Morgan S, Squire LR, Amaral DG.  Human amnesia and the medial temporal region enduring memory impairment following a bilateral lesion limited to field cardiac arrest1 of the hippocampus. J Neurosci . 1986;;6:2950-2967.
20 +
Druhe CM, Hartje W.  Hypoxic amnesia following heart arrest: a neuropsychological case study. Nervenarzt . 1989;;60:280-283.
21 +
Newman S, Pugsley W, Klinger L, Harrison M, Aveling W, Treasure T.  Neuropsychological consequences of circulatory arrest with hypothermia: a case report. J Clin Exp Neuropsychol . 1989;;11: 529-538.
22 +
Laplane D, Levasseur M, Pillon B, et al.  Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions: a neuropsychological, magnetic resonance imaging and positron tomography study. Brain . 1989;;112:699-725.
23 +
Pickard JD, Murray GD, Illingworth R, et al.  Effect of oral nimodipine on cerebral infarction and outcome after subarachnoid hemorrhage: British aneurysm nimodipine trial. BMJ . 1989;;298:636-642.
24 +
Roine RO, Kaste M, Kinnunen A, Nikki P, Sarna S, Kajaste S.  Nimodipine after resuscitation from out-of-hospital ventricular fibrillation: a placebo-controlled, double-blind, randomized trial. JAMA . 1990;;264:3171-3177.
25 +
Folstein MF, Folstein SE, McHugh PR.  'Mini-Mental State': a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res . 1975;;12:189-198.
26 +
Wechsler D. Manual for the Wechsler Adult Intelligence Scale . New York, NY: Psychological Corp; 1955;.
27 +
Wechsler D.  A standardized memory scale for clinical use. J Psychol . 1945;;19:87-95.
28 +
Lezak MD. Neuropsychological Assessment . New York, NY: Oxford University Press; 1983;.
29 +
Benton AL, Eslinger PJ, Damasio AR.  Normative observations on neuropsychological test performance in old age. J Clin Neuropsychol . 1981;;3: 33-42.
30 +
Christensen A-L. Luria's Neuropsychological Investigation, Text, Manual, Cards . Copenhagen, Denmark: Munksgaard; 1975;.
31 +
Luria AR. The Working Brain . Harmondsworth, England: Penguin Books Ltd; 1973;.
32 +
Radloff LS.  The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas . 1977;;1:385-401.
33 +
Weissmann MM, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ.  Assessing depressive symptoms in five psychiatric populations: a validation study. Am J Epidemiol . 1977;;106:203-214.
34 +
Shinar D, Gross CR, Price TR, Banko M, Bolduc PL, Robinson RG.  Screening for depression in stroke patients: the reliability and validity of the Center for Epidemiological Studies Depression Scale. Stroke . 1986;;17:241-245.
35 +
Derogatis LR. SCL-90-R. Administration, Scoring and Procedures Manual—II . 2nd ed. Towson, Md: Clinical Psychometric Research; 1983;.
36 +
Armitage P, Berry G. Statistical Methods in Medical Research . Oxford, England: Blackwell Scientific Publications; 1987;.
37 +
Dixon WJ, Brown MB, Engelman L, Hill MA, Jennrich RI. BMDP Statistical Software Manual . Berkeley, Calif: University of California Press; 1990;: 1, 2.
38 +
Abikoff H, Alvir J, Hong G.  Logical memory subtest of the Wechsler Memory Scale: age and education norms and alternate-form reliability of two scoring systems. J Clin Exp Neuropsychol . 1987;;9:435-448.
39 +
Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR.  Prehospital ventricular fibrillation: prognosis and follow-up course. N Engl J Med . 1974;; 291:317-321.
40 +
Bergner L, Hallstrom AP, Bergner M, Eisenberg MS, Cobb LA.  Health status of survivors of cardiac arrest and of myocardial infarction controls. Am J Public Health . 1985;;75:1321-1323.
41 +
Forsman M, Olsnes BT, Semb G, Steen PA.  Effects of nimodipine on cerebral blood flow and neuropsychological outcome after cardiac surgery. Br J Anaesth . 1990;;65:514-520.
42 +
Säveland H, Sonesson B, Ljunggren B, Ryman T, Brandt L.  Does intravenous nimodipine treatment influence cognition in patients subjected to early aneurysm operation? Acta Neurol Scand . 1988;; 77:54-59.
43 +
Rome RO, Launes J, Nikkinen P, Lindroth L, Kaste M.  Regional CBF after human cardiac arrest: HM-PAO SPECT study. Arch Neurol . 1991;; 48:625-629.
44 +
Flynn JR.  The mean IQ of Americans: massive gains 1932 to 1978. Psychol Bull . 1984;;95:29-51.
45 +
Larrabee GJ.  Further cautions in interpretation of comparison between the WAIS-R and the Wechsler Memory score. J Clin Exp Neuropsychol . 1987;;9:456-460.
46 +
Botwinick J.  Neuropsychology of aging . In: Filskov SB, Boll TJ, eds. Handbook of Clinical Neuropsychology . New York, NY: John Wiley & Sons Inc; 1981;:135-171.

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