Alexa R Sabedra1, Jeffrey Kristan2, Ketki Raina3, Margo B Holm3, Clifton W Callaway2, Francis X Guyette2, Cameron Dezfulian4, Ankur A Doshi2, Jon C Rittenberger5. 1. School of Medicine, University of Pittsburgh, United States. 2. Department of Emergency Medicine, University of Pittsburgh, United States. 3. Department of Occupational Therapy, University of Pittsburgh, United States. 4. Department of Critical Care Medicine, University of Pittsburgh, United States. 5. Department of Emergency Medicine, University of Pittsburgh, United States. Electronic address: rittjc@upmc.edu.
Abstract
INTRODUCTION: Cardiac arrest commonly results in varying degrees of cognitive injury. Standard outcome measures used in the cardiac arrest cohort do not rigorously evaluate for these injury patterns. We examined the utility of the Computerized Assessment for Mild Cognitive Injury (CAMCI) in cardiac arrest (CA) survivors. We hypothesized that cognitive deficits would be more severe in patients who were comatose on hospital arrival. METHODS: Prospective cohort of CA survivors at a single tertiary care facility where participants received neurocognitive testing using CAMCI. CAMCI results were subdivided into memory, attention, and executive functions. Scores between subjects who were initially comatose and were not comatose following resuscitation were compared using the Mann-Whitney test. RESULTS: Of 72 subjects included, the majority (N=44) were initially comatose following resuscitation with mean age of 54 (±14) years. The majority experienced a good neurologic outcome based on Cerebral Performance Category (N=47; 66%) and Modified Rankin Scale (N=38; 53%). Time from resuscitation to CAMCI testing was not associated with total CAMCI score in this cohort (Pearson's r(2) value -0.1941, p=0.20). Initially comatose and not comatose subjects did not differ in their CAMCI overall scores (p=0.33), or in any subtest areas. The not comatose cohort had 1 subtest for which there was a Moderate Risk for mild cognitive impairment (Nonverbal Accuracy), and 2 for which there was a Moderately Low Risk (Verbal Accuracy and Executive Accuracy). The Comatose cohort had 4 subtests, which were deemed Moderately Low Risk for cognitive impairment (Verbal Accuracy, Attention Accuracy, Executive Accuracy and Nonverbal Accuracy). CONCLUSIONS: In-hospital CAMCI testing suggests memory, attention and executive impairment are commonly in patients following resuscitation from cardiac arrest. Outcome evaluations should test for deficits in memory, attention, and executive function.
INTRODUCTION:Cardiac arrest commonly results in varying degrees of cognitive injury. Standard outcome measures used in the cardiac arrest cohort do not rigorously evaluate for these injury patterns. We examined the utility of the Computerized Assessment for Mild Cognitive Injury (CAMCI) in cardiac arrest (CA) survivors. We hypothesized that cognitive deficits would be more severe in patients who were comatose on hospital arrival. METHODS: Prospective cohort of CA survivors at a single tertiary care facility where participants received neurocognitive testing using CAMCI. CAMCI results were subdivided into memory, attention, and executive functions. Scores between subjects who were initially comatose and were not comatose following resuscitation were compared using the Mann-Whitney test. RESULTS: Of 72 subjects included, the majority (N=44) were initially comatose following resuscitation with mean age of 54 (±14) years. The majority experienced a good neurologic outcome based on Cerebral Performance Category (N=47; 66%) and Modified Rankin Scale (N=38; 53%). Time from resuscitation to CAMCI testing was not associated with total CAMCI score in this cohort (Pearson's r(2) value -0.1941, p=0.20). Initially comatose and not comatose subjects did not differ in their CAMCI overall scores (p=0.33), or in any subtest areas. The not comatose cohort had 1 subtest for which there was a Moderate Risk for mild cognitive impairment (Nonverbal Accuracy), and 2 for which there was a Moderately Low Risk (Verbal Accuracy and Executive Accuracy). The Comatose cohort had 4 subtests, which were deemed Moderately Low Risk for cognitive impairment (Verbal Accuracy, Attention Accuracy, Executive Accuracy and Nonverbal Accuracy). CONCLUSIONS: In-hospital CAMCI testing suggests memory, attention and executive impairment are commonly in patients following resuscitation from cardiac arrest. Outcome evaluations should test for deficits in memory, attention, and executive function.
Authors: Jon C Rittenberger; Samuel A Tisherman; Margo B Holm; Francis X Guyette; Clifton W Callaway Journal: Resuscitation Date: 2011-07-05 Impact factor: 5.262
Authors: Niklas Nielsen; Jørn Wetterslev; Tobias Cronberg; David Erlinge; Yvan Gasche; Christian Hassager; Janneke Horn; Jan Hovdenes; Jesper Kjaergaard; Michael Kuiper; Tommaso Pellis; Pascal Stammet; Michael Wanscher; Matt P Wise; Anders Åneman; Nawaf Al-Subaie; Søren Boesgaard; John Bro-Jeppesen; Iole Brunetti; Jan Frederik Bugge; Christopher D Hingston; Nicole P Juffermans; Matty Koopmans; Lars Køber; Jørund Langørgen; Gisela Lilja; Jacob Eifer Møller; Malin Rundgren; Christian Rylander; Ondrej Smid; Christophe Werer; Per Winkel; Hans Friberg Journal: N Engl J Med Date: 2013-11-17 Impact factor: 91.245
Authors: Patrick J Coppler; Jonathan Elmer; Luis Calderon; Alexa Sabedra; Ankur A Doshi; Clifton W Callaway; Jon C Rittenberger; Cameron Dezfulian Journal: Resuscitation Date: 2015-01-28 Impact factor: 5.262
Authors: Dale M Needham; Judy Davidson; Henry Cohen; Ramona O Hopkins; Craig Weinert; Hannah Wunsch; Christine Zawistowski; Anita Bemis-Dougherty; Susan C Berney; O Joseph Bienvenu; Susan L Brady; Martin B Brodsky; Linda Denehy; Doug Elliott; Carl Flatley; Andrea L Harabin; Christina Jones; Deborah Louis; Wendy Meltzer; Sean R Muldoon; Jeffrey B Palmer; Christiane Perme; Marla Robinson; David M Schmidt; Elizabeth Scruth; Gayle R Spill; C Porter Storey; Marta Render; John Votto; Maurene A Harvey Journal: Crit Care Med Date: 2012-02 Impact factor: 7.598
Authors: Mary C Tierney; Gary Naglie; Ross Upshur; Rahim Moineddin; Jocelyn Charles; R Liisa Jaakkimainen Journal: Alzheimer Dis Assoc Disord Date: 2014 Oct-Dec Impact factor: 2.703
Authors: Sachin Agarwal; Alex Presciutti; William Roth; Elizabeth Matthews; Ashley Rodriguez; David J Roh; Soojin Park; Jan Claassen; Ronald M Lazar Journal: Crit Care Med Date: 2018-02 Impact factor: 7.598
Authors: Alexis Steinberg; Jon C Rittenberger; Maria Baldwin; John Faro; Alexandra Urban; Naoir Zaher; Clifton W Callaway; Jonathan Elmer Journal: Resuscitation Date: 2017-12-05 Impact factor: 5.262
Authors: Thomas Uray; Andrew Lamade; Jonathan Elmer; Tomas Drabek; Jason P Stezoski; Amalea Missé; Keri Janesko-Feldman; Robert H Garman; Niel Chen; Patrick M Kochanek; Cameron Dezfulian; Clifton W Callaway; Ankur A Doshi; Adam Frisch; Francis X Guyette; Josh C Reynolds; Jon C Rittenberger Journal: Crit Care Med Date: 2018-06 Impact factor: 7.598
Authors: Katharyn L Flickinger; Stephany Jaramillo; Melissa J Repine; Allison C Koller; Margo Holm; Elizabeth Skidmore; Clif Callaway; Jon C Rittenberger Journal: Resusc Plus Date: 2021-12-06
Authors: Anne V Grossestreuer; Benjamin S Abella; Kelsey R Sheak; Marisa J Cinousis; Sarah M Perman; Marion Leary; Douglas J Wiebe; David F Gaieski Journal: Resuscitation Date: 2016-09-17 Impact factor: 5.262
Authors: Jerry P Nolan; Claudio Sandroni; Bernd W Böttiger; Alain Cariou; Tobias Cronberg; Hans Friberg; Cornelia Genbrugge; Kirstie Haywood; Gisela Lilja; Véronique R M Moulaert; Nikolaos Nikolaou; Theresa Mariero Olasveengen; Markus B Skrifvars; Fabio Taccone; Jasmeet Soar Journal: Intensive Care Med Date: 2021-03-25 Impact factor: 17.440
Authors: Eric Fagerli; Iris Escobar; Fernando J Ferrier; Charles W Jackson; Efrain J Perez-Lao; Miguel A Perez-Pinzon Journal: Front Physiol Date: 2022-07-22 Impact factor: 4.755