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In-hospital cardiac arrest leads to chronic memory impairment
Samantha M O'Reilly1, Neil R Grubb, Ronan E O'Carroll
1School of Psychology, University of St. Andrews, St. Andrews, Fife KY16 9JU, UK. smo@st-and.ac.uk
Insights
Memory deficits are common in patients surviving in-hospital cardiac arrest (IHCA). IHCA survivors experience significant memory impairment, similar to out-of-hospital cardiac arrest (OHCA) patients.
Area of Science:
- Neurology
- Cardiology
- Critical Care Medicine
Background:
- In-hospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) are critical events with potential neurological sequelae.
- Memory deficits are a known complication following cardiac arrest, but direct comparisons between IHCA and OHCA survivors are less understood.
- Acute myocardial infarction (MI) serves as a relevant control group for assessing non-arrest related cognitive changes.
Purpose of the Study:
- To evaluate and compare the prevalence and severity of memory deficits in IHCA survivors versus OHCA survivors.
- To contrast the cognitive outcomes of cardiac arrest survivors with those of patients who experienced acute myocardial infarction without cardiac arrest.
- To determine if IHCA is associated with a different profile of memory impairment compared to OHCA.
Main Methods:
- A comparative study involving 35 IHCA survivors, 35 OHCA survivors, and 35 acute myocardial infarction (MI) patients without cardiac arrest.
- Cognitive function, including short-term and long-term episodic memory, was assessed using standardized tests (digit span, Rivermead behavioural memory test-RBMT).
- Participants also underwent assessment for affective state (Hospital Anxiety and Depression Scale) and pre-morbid intelligence (National Adult Reading Test) approximately 8 months post-event.
Main Results:
- IHCA survivors demonstrated lower scores on the Rivermead Behavioural Memory Test (RBMT) compared to MI controls.
- Moderate to severe memory impairment was identified in 26% of IHCA survivors and 38% of OHCA survivors.
- Both IHCA and OHCA groups exhibited significantly greater memory impairment than the MI control group, with no statistically significant difference between the two cardiac arrest groups.
Conclusions:
- Clinically significant memory impairment affects approximately one in four patients after surviving an in-hospital cardiac arrest.
- The potentially shorter arrest durations in IHCA may not adequately protect against memory deficits resulting from cerebral hypoxia.
- Memory impairment is a considerable concern for survivors of both in-hospital and out-of-hospital cardiac arrest, underscoring the need for targeted neurocognitive assessment and rehabilitation.
Objective:
To assess the prevalence and severity of memory deficits in a group of patients who survived an in-hospital cardiac arrest (IHCA) in comparison with patients resuscitated after cardiac arrest outside hospital (OHCA) and patients with acute myocardial infarction (MI).
Subjects:
Thirty-five IHCA survivors, 35 OHCA survivors, and 35 patients who had suffered MI uncomplicated by cardiac arrest.
Procedure:
Participants were assessed 8.2 (4.5) months after the event for current affective state (Hospital anxiety and depression scale (HADS)), pre-morbid intelligence (National adult reading test (NART)), short-term memory (digit span test) and long-term episodic memory (Rivermead behavioural memory test-RBMT).
Results:
IHCA patients scored lower on the RBMT than MI controls but did not score significantly differently OHCA patients. Moderate or severe memory impairment was found in 26% of the IHCA group and 38% of the OHCA group. None of the MI group was found to have this degree of impairment. This difference in prevalence of memory impairment between the two cardiac arrest groups was not statistically significant. However, both arrest groups had significantly greater memory impairment than the MI control group.
Conclusions:
Clinically important memory impairment was found in one in four patients surviving IHCA. The shorter arrest durations that are thought to be associated with IHCA may not be sufficient to protect patients from memory impairment associated with cerebral hypoxia.