| 1. |
- Blennow Nordström, Erik, et al.
(författare)
-
Serum neurofilament light levels are correlated to long-term neurocognitive outcome measures after cardiac arrest
- 2022
-
Ingår i: Brain Injury. - : Informa UK Limited. - 0269-9052 .- 1362-301X. ; 36:6, s. 800-809
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To explore associations between four methods assessing long-term neurocognitive outcome after out-of-hospital cardiac arrest and early hypoxic-ischemic neuronal brain injury assessed by the biomarker serum neurofilament light (NFL), and to compare the agreement for the outcome methods. Methods An explorative post-hoc study was conducted on survivor data from the international Target Temperature Management after Out-of-hospital Cardiac Arrest trial, investigating serum NFL sampled 48/72-hours post-arrest and neurocognitive outcome 6 months post-arrest. Results Among the long-term surviving participants (N = 457), serum NFL (n = 384) was associated to all outcome instruments, also when controlling for demographic and cardiovascular risk factors. Associations between NFL and the patient-reported Two Simple Questions (TSQ) were however attenuated when adjusting for vitality and mental health. NFL predicted results on the outcome instruments to varying degrees, with an excellent area under the curve for the clinician-report Cerebral Performance Category (CPC 1-2: 0.90). Most participants were classified as CPC 1 (79%). Outcome instrument correlations ranged from small (Mini-Mental State Examination [MMSE]-TSQ) to strong (CPC-MMSE). Conclusions The clinician-reported CPC was mostly related to hypoxic-ischemic brain injury, but with a ceiling effect. These results may be useful when selecting methods and instruments for clinical follow-up models.
|
|
| 2. |
- Robba, Chiara, et al.
(författare)
-
Oxygen targets and 6-month outcome after out of hospital cardiac arrest : a pre-planned sub-analysis of the targeted hypothermia versus targeted normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial
- 2022
-
Ingår i: Critical Care. - : Springer Science and Business Media LLC. - 1364-8535 .- 1466-609X. ; 26, s. 1-13
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Optimal oxygen targets in patients resuscitated after cardiac arrest are uncertain. The primary aim of this study was to describe the values of partial pressure of oxygen values (PaO2) and the episodes of hypoxemia and hyperoxemia occurring within the first 72 h of mechanical ventilation in out of hospital cardiac arrest (OHCA) patients. The secondary aim was to evaluate the association of PaO2 with patients’ outcome. Methods: Preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after OHCA (TTM2) trial. Arterial blood gases values were collected from randomization every 4 h for the first 32 h, and then, every 8 h until day 3. Hypoxemia was defined as PaO2 < 60 mmHg and severe hyperoxemia as PaO2 > 300 mmHg. Mortality and poor neurological outcome (defined according to modified Rankin scale) were collected at 6 months. Results: 1418 patients were included in the analysis. The mean age was 64 ± 14 years, and 292 patients (20.6%) were female. 24.9% of patients had at least one episode of hypoxemia, and 7.6% of patients had at least one episode of severe hyperoxemia. Both hypoxemia and hyperoxemia were independently associated with 6-month mortality, but not with poor neurological outcome. The best cutoff point associated with 6-month mortality for hypoxemia was 69 mmHg (Risk Ratio, RR = 1.009, 95% CI 0.93–1.09), and for hyperoxemia was 195 mmHg (RR = 1.006, 95% CI 0.95–1.06). The time exposure, i.e., the area under the curve (PaO2-AUC), for hyperoxemia was significantly associated with mortality (p = 0.003). Conclusions: In OHCA patients, both hypoxemia and hyperoxemia are associated with 6-months mortality, with an effect mediated by the timing exposure to high values of oxygen. Precise titration of oxygen levels should be considered in this group of patients. Trial registration: clinicaltrials.gov NCT02908308, Registered September 20, 2016.
|
|
| 3. |
- Robba, Chiara, et al.
(författare)
-
Ventilatory settings in the initial 72 h and their association with outcome in out-of-hospital cardiac arrest patients : a preplanned secondary analysis of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
- 2022
-
Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 48:8, s. 1024-1038
-
Tidskriftsartikel (refereegranskat)abstract
- Purpose: The optimal ventilatory settings in patients after cardiac arrest and their association with outcome remain unclear. The aim of this study was to describe the ventilatory settings applied in the first 72 h of mechanical ventilation in patients after out-of-hospital cardiac arrest and their association with 6-month outcomes. Methods: Preplanned sub-analysis of the Target Temperature Management-2 trial. Clinical outcomes were mortality and functional status (assessed by the Modified Rankin Scale) 6 months after randomization. Results: A total of 1848 patients were included (mean age 64 [Standard Deviation, SD = 14] years). At 6 months, 950 (51%) patients were alive and 898 (49%) were dead. Median tidal volume (VT) was 7 (Interquartile range, IQR = 6.2–8.5) mL per Predicted Body Weight (PBW), positive end expiratory pressure (PEEP) was 7 (IQR = 5–9) cmH20, plateau pressure was 20 cmH20 (IQR = 17–23), driving pressure was 12 cmH20 (IQR = 10–15), mechanical power 16.2 J/min (IQR = 12.1–21.8), ventilatory ratio was 1.27 (IQR = 1.04–1.6), and respiratory rate was 17 breaths/minute (IQR = 14–20). Median partial pressure of oxygen was 87 mmHg (IQR = 75–105), and partial pressure of carbon dioxide was 40.5 mmHg (IQR = 36–45.7). Respiratory rate, driving pressure, and mechanical power were independently associated with 6-month mortality (omnibus p-values for their non-linear trajectories: p < 0.0001, p = 0.026, and p = 0.029, respectively). Respiratory rate and driving pressure were also independently associated with poor neurological outcome (odds ratio, OR = 1.035, 95% confidence interval, CI = 1.003–1.068, p = 0.030, and OR = 1.005, 95% CI = 1.001–1.036, p = 0.048). A composite formula calculated as [(4*driving pressure) + respiratory rate] was independently associated with mortality and poor neurological outcome. Conclusions: Protective ventilation strategies are commonly applied in patients after cardiac arrest. Ventilator settings in the first 72 h after hospital admission, in particular driving pressure and respiratory rate, may influence 6-month outcomes.
|
|
| 4. |
- Andrell, Cecilia, et al.
(författare)
-
"Tid är liv – därför bör Skåne införa sms-livräddning nu"
- 2022
-
Ingår i: Sydsvenskan. - 1652-814X. ; , s. 3-3
-
Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Eight researchers at the Lund University Center for Cardiac Arrest write that every minute of delay in cardiopulmonary resuscitation reduces the chance of survival by 10 percent.
|
|
| 5. |
|
|
| 6. |
- Blennow Nordström, Erik, et al.
(författare)
-
Assessment of neurocognitive function after cardiac arrest
- 2019
-
Ingår i: Current Opinion in Critical Care. - 1531-7072. ; 25:3, s. 234-239
-
Tidskriftsartikel (refereegranskat)abstract
- PURPOSE OF REVIEW: Impaired neurocognitive function is common in cardiac arrest survivors and the use of specific neurocognitive assessments are recommended in both clinical trials and daily practice. This review examines the most recent evidence to guide in the selection of neurocognitive outcome assessment tools after cardiac arrest. RECENT FINDINGS: Neurocognitive impairment after cardiac arrest was recently reported as one of the major predictors for societal participation, highlighting the need for neurocognitive assessments. A subjective report is a simple method to screen for cognitive problems, but divergent findings were reported when comparing with objective measures. A standardized observer report may be useful for cognitive screening postcardiac arrest. The Montreal Cognitive Assessment (MoCA) was recommended for cognitive screening after cardiac arrest. Detailed neurocognitive assessments were reported as valuable for in-depth evaluation of patients in interventional studies. The best time-point for neurocognitive assessments remains unknown. Recent findings report that most neurocognitive recovery is seen within the first months after cardiac arrest, with some improvement also noted between 3 and 12 months postcardiac arrest. SUMMARY: Neurocognitive assessments after cardiac arrest are important and the approach should differ depending on the clinical situation. Large, prospective, well designed studies, to guide the selection of neurocognitive assessments after cardiac arrest, are urgently needed.
|
|
| 7. |
|
|
| 8. |
|
|
| 9. |
- Blennow Nordström, Erik
(författare)
-
Neurocognitive function following out-of-hospital cardiac arrest
- 2022
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The brain is susceptible to hypoxic-ischemic brain injury in conjuction with out-of-hospital cardiac arrest (OHCA). Cognitive impairments are documented in about half of all OHCA survivors, however with a pronounced heterogeneity in measurements and findings. More detailed studies and instruments that are sensitive to OHCA-related cognitive impairment, including predictive models to identify individuals at risk, are needed. It is also unclear how different neurocognitive outcome methods are related to each other, to the brain injury, and to associated factors.Aims: The overall aim of this thesis was to explore the extent of neurocognitive impairment following OHCA in the late recovery phase. Specific aims per papers included in this thesis were: I) To examine the psychometric properties of an observer-reported questionnaire modified for usage after cardiac arrest, the Informant Questionnaire on Cognitive Decline in the Elderly-Cardiac Arrest (IQCODE-CA). II) To explore associations between four neurocognitive outcome methods administered in the late recovery phase and early hypoxic-ischemic brain injury assessed by the biomarker serum neurofilament light (NFL), and to compare the agreement for the four outcome methods. III) To describe the rationale and, IV) report initial results of detailed assessment of neurocognitive impairment in OHCA survivors, compare the cognitive performance to a cohort of participants following acute myocardial infarction (MI), and investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors.Methods: I & II) Post-hoc analyses of surviving participants of the international multicenter Target temperature management 33 °C versus 36 °C after out-of-hospital cardiac arrest trial (TTM-trial), its biobank, and its cognitive sub-study, with a follow-up at 6 months post-arrest. III & IV) Prospective inclusion of surviving participants of the international multicenter Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2-trial) at neuropsychological sub-study sites, recruitment of a matched non-arrest control group with acute MI, and an extensive neuropsychological assessment at approximately 7 months post-cardiac event.Results: I) The IQCODE-CA had acceptable psychometric properties and may be used alongside with performance-based measures when screening for post-arrest cognitive impairment. II) The clinician-report Cerebral Performance Category was mostly related to brain injury according to NFL, but with a ceiling effect. Although associations between patient-reports and performance-based measures were weak, all four outcome methods correlated significantly with each other. III & IV) Cognitive impairment on neuropsychological tests was generally mild among OHCA survivors (29% had at least borderline–mild impairment in ≥ 2 cognitive domains, and 14% had major impairment in ≥ 1 cognitive domain), but most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed worse than MI controls. Diabetes and symptoms of anxiety, depression, and fatigue were associated with worse cognitive performance among the OHCA survivors.Conclusions: Cognitive impairment following OHCA is common. A post-OHCA follow-up service should screen for cognitive impairment using different neurocognitive outcome methods with acceptable psychometric properties. Since cognitive impairment is interrelated with emotional problems and fatigue, these areas should also be covered within routine screening. Patients with signs of impairment could be referred to neuropsychological assessment or team-based cognitive rehabilitation programs to optimize their recovery and long-term outcome.
|
|
| 10. |
- Blennow Nordström, Erik, et al.
(författare)
-
Neuropsychological outcome after cardiac arrest : results from a sub-study of the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest (TTM2) trial
- 2023
-
Ingår i: Critical Care. - : BioMed Central (BMC). - 1364-8535 .- 1466-609X. ; 27:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Cognitive impairment is common following out-of-hospital cardiac arrest (OHCA), but the nature of the impairment is poorly understood. Our objective was to describe cognitive impairment in OHCA survivors, with the hypothesis that OHCA survivors would perform significantly worse on neuropsychological tests of cognition than controls with acute myocardial infarction (MI). Another aim was to investigate the relationship between cognitive performance and the associated factors of emotional problems, fatigue, insomnia, and cardiovascular risk factors following OHCA.METHODS: This was a prospective case-control sub-study of The Targeted Hypothermia versus Targeted Normothermia after Out-of-Hospital Cardiac Arrest (TTM2) trial. Eight of 61 TTM2-sites in Sweden, Denmark, and the United Kingdom included adults with OHCA of presumed cardiac or unknown cause. A matched non-arrest control group with acute MI was recruited. At approximately 7 months post-event, we administered an extensive neuropsychological test battery and questionnaires on anxiety, depression, fatigue, and insomnia, and collected information on the cardiovascular risk factors hypertension and diabetes.RESULTS: Of 184 eligible OHCA survivors, 108 were included, with 92 MI controls enrolled. Amongst OHCA survivors, 29% performed z-score ≤ - 1 (at least borderline-mild impairment) in ≥ 2 cognitive domains, 14% performed z-score ≤ - 2 (major impairment) in ≥ 1 cognitive domain while 54% performed without impairment in any domain. Impairment was most pronounced in episodic memory, executive functions, and processing speed. OHCA survivors performed significantly worse than MI controls in episodic memory (mean difference, MD = - 0.37, 95% confidence intervals [- 0.61, - 0.12]), verbal (MD = - 0.34 [- 0.62, - 0.07]), and visual/constructive functions (MD = - 0.26 [- 0.47, - 0.04]) on linear regressions adjusted for educational attainment and sex. When additionally adjusting for anxiety, depression, fatigue, insomnia, hypertension, and diabetes, executive functions (MD = - 0.44 [- 0.82, - 0.06]) were also worse following OHCA. Diabetes, symptoms of anxiety, depression, and fatigue were significantly associated with worse cognitive performance.CONCLUSIONS: In our study population, cognitive impairment was generally mild following OHCA. OHCA survivors performed worse than MI controls in 3 of 6 domains. These results support current guidelines that a post-OHCA follow-up service should screen for cognitive impairment, emotional problems, and fatigue.TRIAL REGISTRATION: ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
|
|
