Neuropsychological Sequelae of Cardiac Arrest

Abstract

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 2 1/2 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 micrograms/kg as an intravenous injection immediately after restoration of spontaneous circulation, followed by an infusion of 0.5 micrograms/kg per minute for 24 hours. RESULTS: Three months after cardiac arrest, 41 (60%) 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.