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.
Cardiovascular disease
Cognitive impairment
Heart arrest
Hypoxic-ischemic encephalopathy
Myocardial infarction
Outcome
Journal
Critical care (London, England)
ISSN: 1466-609X
Titre abrégé: Crit Care
Pays: England
ID NLM: 9801902
Informations de publication
Date de publication:
26 08 2023
26 08 2023
Historique:
received:
02
06
2023
accepted:
16
08
2023
medline:
28
8
2023
pubmed:
27
8
2023
entrez:
26
8
2023
Statut:
epublish
Résumé
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. 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. 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. 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. ClinicalTrials.gov, NCT03543371. Registered 1 June 2018.
Sections du résumé
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.
Identifiants
pubmed: 37633944
doi: 10.1186/s13054-023-04617-0
pii: 10.1186/s13054-023-04617-0
pmc: PMC10463667
doi:
Banques de données
ClinicalTrials.gov
['NCT03543371']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
328Subventions
Organisme : Skane University Hospital Foundations
ID : 2019-o000032
Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Yan S, Gan Y, Jiang N, Wang R, Chen Y, Luo Z, Zong Q, Chen S, Lv C. The global survival rate among adult out-of-hospital cardiac arrest patients who received cardiopulmonary resuscitation: a systematic review and meta-analysis. Crit Care. 2020;24(1):61.
pubmed: 32087741
pmcid: 7036236
doi: 10.1186/s13054-020-2773-2
Boyce LW, Goossens PH. Rehabilitation after cardiac arrest: integration of neurologic and cardiac rehabilitation. Semin Neurol. 2017;37(01):094–102.
doi: 10.1055/s-0036-1593860
Sandroni C, Cronberg T, Sekhon M. Brain injury after cardiac arrest: pathophysiology, treatment, and prognosis. Intensive Care Med. 2021;47(12):1393–414.
pubmed: 34705079
pmcid: 8548866
doi: 10.1007/s00134-021-06548-2
Moulaert VRMP, Verbunt JA, van Heugten CM, Wade DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2009;80(3):297–305.
pubmed: 19117659
doi: 10.1016/j.resuscitation.2008.10.034
Zook N, Voss S, Blennow Nordström E, Brett SJ, Jenkinson E, Shaw P, White P, Benger J. Neurocognitive function following out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2022;170:238–46.
pubmed: 34648921
doi: 10.1016/j.resuscitation.2021.10.005
Peskine A, Rosso C, Picq C, Caron E, Pradat-Diehl P. Neurological sequelae after cerebral anoxia. Brain Inj. 2010;24(5):755–61.
pubmed: 20370382
doi: 10.3109/02699051003709581
van Alem AP, de Vos R, Schmand B, Koster RW. Cognitive impairment in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148(3):416–21.
pubmed: 15389227
doi: 10.1016/j.ahj.2004.01.031
Lilja G, Nielsen N, Bro-Jeppesen J, Dunford H, Friberg H, Hofgren C, Horn J, Insorsi A, Kjaergaard J, Nilsson F, et al. Return to work and participation in society after out-of-hospital cardiac arrest. Circ Cardiovasc Qual Outcomes. 2018;11(1): e003566.
pubmed: 29326145
doi: 10.1161/CIRCOUTCOMES.117.003566
Middelkamp W, Moulaert VR, Verbunt JA, van Heugten CM, Bakx WG, Wade DT. Life after survival: long-term daily life functioning and quality of life of patients with hypoxic brain injury as a result of a cardiac arrest. Clin Rehabil. 2007;21(5):425–31.
pubmed: 17613563
doi: 10.1177/0269215507075307
Lilja G, Nielsen N, Friberg H, Horn J, Kjaergaard J, Nilsson F, Pellis T, Wetterslev J, Wise MP, Bosch F, et al. Cognitive function in survivors of out-of-hospital cardiac arrest after target temperature management at 33 degrees C versus 36 degrees C. Circulation. 2015;131(15):1340–9.
pubmed: 25681466
doi: 10.1161/CIRCULATIONAHA.114.014414
Yaow CYL, Teoh SE, Lim WS, Wang RSQ, Han MX, Pek PP, Tan BY-Q, Ong MEH, Ng QX, Ho AFW. Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2022;170:82–91.
pubmed: 34826580
doi: 10.1016/j.resuscitation.2021.11.023
Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Bělohlávek J, Callaway C, Cariou A, Eastwood G, Erlinge D, Hovdenes J, et al. Targeted hypothermia versus targeted Normothermia after out-of-hospital cardiac arrest (TTM2): a randomized clinical trial—rationale and design. Am Heart J. 2019;217:23–31.
pubmed: 31473324
doi: 10.1016/j.ahj.2019.06.012
Dankiewicz J, Cronberg T, Lilja G, Jakobsen JC, Levin H, Ullén S, Rylander C, Wise MP, Oddo M, Cariou A, et al. Hypothermia versus normothermia after out-of-hospital cardiac arrest. N Engl J Med. 2021;384(24):2283–94.
pubmed: 34133859
doi: 10.1056/NEJMoa2100591
Blennow Nordström E, Lilja G, Vestberg S, Ullén S, Friberg H, Nielsen N, Heimburg K, Evald L, Mion M, Segerström M, et al. Neuropsychological outcome after cardiac arrest: a prospective case control sub-study of the Targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2). BMC Cardiovasc Disord. 2020;20(1):439.
pubmed: 33028221
pmcid: 7542852
doi: 10.1186/s12872-020-01721-9
Lilja G, Nielsen N, Ullen S, Blennow Nordstrom E, Dankiewicz J, Friberg H, Heimburg K, Jakobsen JC, Levin H, Callaway C, et al. Protocol for outcome reporting and follow-up in the targeted hypothermia versus targeted normothermia after out-of-hospital cardiac arrest trial (TTM2). Resuscitation. 2020;150:104–12.
pubmed: 32205155
doi: 10.1016/j.resuscitation.2020.03.004
Rockwood K, Song X, MacKnight CB, Howard HDB, McDowell I, Mitnitski A. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.
pubmed: 16129869
pmcid: 1188185
doi: 10.1503/cmaj.050051
Wechsler D. Wechsler adult intelligence scale—fourth edition (WAIS-IV). San Antonio: Pearson Assessment; 2008.
Delis DC, Kaplan E, Kramer JH. Delis–Kaplan executive function system (D-KEFS). San Antonio: The Psychological Corporation; 2001.
Wechsler D. Wechsler memory scale—third edition (WMS-III). San Antonio: The Psychological Corporation; 1997.
Rey A. Rey auditory verbal learning test (RAVLT): Western psychological services; 1958.
Benedict RH. Brief visuospatial memory test—revised (BVMT-R). Odessa: Psychological Assessment Resources, Inc; 1997.
Reitan RM. Validity of the Trail Making Test as an indicator of organic brain damage. Percept Mot Skills. 1958;8:271–6.
doi: 10.2466/pms.1958.8.3.271
American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Association; 2013.
doi: 10.1176/appi.books.9780890425596
Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361–70.
pubmed: 6880820
doi: 10.1111/j.1600-0447.1983.tb09716.x
Smets EMA, Garssen B, Bonke B, De Haes JCJM. The multidimensional Fatigue Inventory (MFI) psychometric qualities of an instrument to assess fatigue. J Psychosom Res. 1995;39(3):315–25.
pubmed: 7636775
doi: 10.1016/0022-3999(94)00125-O
Broman J-E, Smedje H, Mallon L, Hetta J. The Minimal Insomnia Symptom Scale (MISS). Upsala J Med Sci. 2008;113(2):131–42.
pubmed: 18509808
doi: 10.3109/2000-1967-221
van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke J Cereb Circ. 1988;19(5):604–7.
doi: 10.1161/01.STR.19.5.604
Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale: L. Erlbaum Associates; 1988.
Nasreddine ZS, Phillips NA, Bédirian V, Charbonneau S, Whitehead V, Collin I, Cummings JL, Chertkow H. The Montreal cognitive assessment, MoCA: a brief screening tool for mild cognitive impairment. J Am Geriatr Soc. 2005;53(4):695–9.
pubmed: 15817019
doi: 10.1111/j.1532-5415.2005.53221.x
Evald L, Brønnick K, Duez CHV, Grejs AM, Jeppesen AN, Søreide E, Kirkegaard H, Nielsen JF. Prolonged targeted temperature management reduces memory retrieval deficits six months post-cardiac arrest: a randomised controlled trial. Resuscitation. 2019;134:1–9.
pubmed: 30572070
doi: 10.1016/j.resuscitation.2018.12.002
Meador KJ. Cognitive side effects of medications. Neurol Clin. 1998;16(1):141–55.
pubmed: 9421545
doi: 10.1016/S0733-8619(05)70371-6
Rousseau A-F, Prescott HC, Brett SJ, Weiss B, Azoulay E, Creteur J, Latronico N, Hough CL, Weber-Carstens S, Vincent J-L, et al. Long-term outcomes after critical illness: recent insights. Crit Care. 2021;25(1):108.
pubmed: 33731201
pmcid: 7968190
doi: 10.1186/s13054-021-03535-3
Lilja G, Ullén S, Dankiewicz J, Friberg H, Levin H, Blennow Nordström E, Heimburg K, Jakobsen JC, Ahlqvist M, Bass F et al. Effects of hypothermia vs normothermia on societal participation and cognitive function at 6 months in survivors after out-of-hospital cardiac arrest: a predefined analysis of the TTM2 randomized clinical trial. JAMA Neurol. 2023.
Byron-Alhassan A, Collins B, Bedard M, Quinlan B, Le May M, Duchesne L, Osborne C, Wells G, Smith AM, Tulloch HE. Cognitive dysfunction after out-of-hospital cardiac arrest: rate of impairment and clinical predictors. Resuscitation. 2021;165:154–60.
pubmed: 33991604
doi: 10.1016/j.resuscitation.2021.05.002
Mion M, Magee N, Davis J, Farrell K, Nikolopoulou E, Jessup D, Davies J, Karamasis G, Keeble T. Exploring cognitive impairment in the early stages of an out-of-hospital cardiac arrest—a consecutive case series study. Neuropsychol Rehab. 2022;25:1–18.
Polanowska K, Sarzyńska-Długosz I, Paprot A, Sikorska Ś, Seniów J, Karpiński G, Kowalik R, Opolski G, Członkowska A. Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study. Kardiol Polska (Pol Heart J). 2014;72(9):814–22.
doi: 10.5603/KP.a2014.0087
Steinbusch CVM, van Heugten CM, Rasquin SMC, Verbunt JA, Moulaert VRM. Cognitive impairments and subjective cognitive complaints after survival of cardiac arrest: a prospective longitudinal cohort study. Resuscitation. 2017;120(Supplement C):132–7.
pubmed: 28818523
doi: 10.1016/j.resuscitation.2017.08.007
Lilja G, Nilsson G, Nielsen N, Friberg H, Hassager C, Koopmans M, Kuiper M, Martini A, Mellinghoff J, Pelosi P, et al. Anxiety and depression among out-of-hospital cardiac arrest survivors. Resuscitation. 2015;97:68–75.
pubmed: 26433116
doi: 10.1016/j.resuscitation.2015.09.389
Hammar Å, Ronold EH, Rekkedal GÅ. Cognitive impairment and neurocognitive profiles in major depression—a clinical perspective. Front Psychiatry. 2022;1:3.
Castaneda AE, Tuulio-Henriksson A, Marttunen M, Suvisaari J, Lönnqvist J. A review on cognitive impairments in depressive and anxiety disorders with a focus on young adults. J Affect Disord. 2008;106(1):1–27.
pubmed: 17707915
doi: 10.1016/j.jad.2007.06.006
Åkerlund E, Sunnerhagen KS, Persson HC. Fatigue after acquired brain injury impacts health-related quality of life: an exploratory cohort study. Sci Rep. 2021;11(1):22153.
pubmed: 34773047
pmcid: 8590006
doi: 10.1038/s41598-021-01617-4
Johansson B. Mental fatigue after mild traumatic brain injury in relation to cognitive tests and brain imaging methods. Int J Environ Res Public Health. 2021;18(11):5955.
pubmed: 34199339
pmcid: 8199529
doi: 10.3390/ijerph18115955
Hadley G, Zhang J, Harris-Skillman E, Alexopoulou Z, DeLuca GC, Pendlebury ST. Cognitive decline and diabetes: a systematic review of the neuropathological correlates accounting for cognition at death. J Neurol Neurosurg Psychiatry. 2022;93(3):246.
pubmed: 35086942
doi: 10.1136/jnnp-2021-328158
Batelaan NM, Seldenrijk A, van den Heuvel OA, van Balkom AJLM, Kaiser A, Reneman L, Tan HL. Anxiety, mental stress, and sudden cardiac arrest: epidemiology, possible mechanisms and future research. Front Psychiatry. 2022;12:813518.
pubmed: 35185641
pmcid: 8850954
doi: 10.3389/fpsyt.2021.813518
Cheng G, Huang C, Deng H, Wang H. Diabetes as a risk factor for dementia and mild cognitive impairment: a meta-analysis of longitudinal studies. Intern Med J. 2012;42(5):484–91.
pubmed: 22372522
doi: 10.1111/j.1445-5994.2012.02758.x
Qiu C, Fratiglioni L. A major role for cardiovascular burden in age-related cognitive decline. Nat Rev Cardiol. 2015;12(5):267–77.
pubmed: 25583619
doi: 10.1038/nrcardio.2014.223
Blennow Nordström E, Lilja G, Ullén S, Blennow K, Friberg H, Hassager C, Kjærgaard J, Mattsson-Carlgren N, Moseby-Knappe M, Nielsen N, et al. Serum neurofilament light levels are correlated to long-term neurocognitive outcome measures after cardiac arrest. Brain Inj. 2022;36(6):800–9.
pubmed: 35253570
doi: 10.1080/02699052.2022.2048693
Kennedy SH. Core symptoms of major depressive disorder: relevance to diagnosis and treatment. Dialogues Clin Neurosci. 2008;10(3):271–7.
pubmed: 18979940
pmcid: 3181882
doi: 10.31887/DCNS.2008.10.3/shkennedy
Haywood K, Whitehead L, Nadkarni VM, Achana F, Beesems S, Böttiger BW, Brooks A, Castrén M, Ong MEH, Hazinski MF, et al. COSCA (core outcome set for cardiac arrest) in adults: an advisory statement from the international liaison committee on resuscitation. Circulation. 2018;137(22):e783–801.
pubmed: 29700122
doi: 10.1161/CIR.0000000000000562
Fugate JE, Moore SA, Knopman DS, Claassen DO, Wijdicks EF, White RD, Rabinstein AA. Cognitive outcomes of patients undergoing therapeutic hypothermia after cardiac arrest. Neurology. 2013;81(1):40–5.
pubmed: 23685933
pmcid: 3770208
doi: 10.1212/WNL.0b013e318297ee7e
Braun RG, Heitsch L, Cole JW, Lindgren AG, de Havenon A, Dude JA, Lohse KR, Cramer SC, Worrall BB. Domain-specific outcomes for stroke clinical trials: what the modified Rankin isn’t ranking. Neurology. 2021;97(8):367–77.
pubmed: 34172537
pmcid: 8397584
doi: 10.1212/WNL.0000000000012231
Alexander MP, Lafleche G, Schnyer D, Lim C, Verfaellie M. Cognitive and functional outcome after out of hospital cardiac arrest. J Int Neuropsychol Soc. 2011;17(02):364–8.
pubmed: 21208480
pmcid: 4053182
doi: 10.1017/S1355617710001633
Juan E, De Lucia M, Beaud V, Oddo M, Rusca M, Viceic D, Clarke S, Rossetti AO. How do you feel? Subjective perception of recovery as a reliable surrogate of cognitive and functional outcome in cardiac arrest survivors. Crit Care Med. 2018;46(4):e286–93.
pubmed: 29309370
doi: 10.1097/CCM.0000000000002946
Lim C, Verfaellie M, Schnyer D, Lafleche G, Alexander MP. Recovery, long-term cognitive outcome and quality of life following out-of-hospital cardiac arrest. J Rehabil Med. 2014;46(7):691–7.
pubmed: 24849762
doi: 10.2340/16501977-1816
Mateen FJ, Josephs KA, Trenerry MR, Felmlee-Devine MD, Weaver AL, Carone M, White RD. Long-term cognitive outcomes following out-of-hospital cardiac arrest: a population-based study. Neurology. 2011;77(15):1438–45.
pubmed: 21917772
doi: 10.1212/WNL.0b013e318232ab33
Ørbo M, Aslaksen PM, Larsby K, Schäfer C, Tande PM, Anke A. Alterations in cognitive outcome between 3 and 12 months in survivors of out-of-hospital cardiac arrest. Resuscitation. 2016;105:92–9.
pubmed: 27255953
doi: 10.1016/j.resuscitation.2016.05.017
Tiainen M, Poutiainen E, Oksanen T, Kaukonen K-M, Pettilä V, Skrifvars M, Varpula T, Castrén M. Functional outcome, cognition and quality of life after out-of-hospital cardiac arrest and therapeutic hypothermia: data from a randomized controlled trial. Scand J Trauma Resusc Emerg Med. 2015;23(1):12.
pubmed: 25652686
pmcid: 4344753
doi: 10.1186/s13049-014-0084-9
Haywood KL, Dainty KN, Swartz R. The what, when, how and who of neurocognitive function: the importance of assessment quality and community engagement. Resuscitation. 2022;170:247–9.
pubmed: 34838663
doi: 10.1016/j.resuscitation.2021.11.024
Nolan JP, Sandroni C, Böttiger BW, Cariou A, Cronberg T, Friberg H, Genbrugge C, Haywood K, Lilja G, Moulaert VRM, et al. European Resuscitation Council and European Society of Intensive Care Medicine Guidelines 2021: post-resuscitation care. Resuscitation. 2021;161:220–69.
pubmed: 33773827
doi: 10.1016/j.resuscitation.2021.02.012
Mion M, Case R, Smith K, Lilja G, Blennow Nordström E, Swindell P, Nikolopoulou E, Davis J, Farrell K, Gudde E, et al. Follow-up care after out-of-hospital cardiac arrest: a pilot study of survivors and families’ experiences and recommendations. Resuscitation Plus. 2021;7: 100154.
pubmed: 34386781
pmcid: 8342775
doi: 10.1016/j.resplu.2021.100154
Moulaert VRM, van Heugten CM, Winkens B, Bakx WGM, de Krom MCFTM, Gorgels TPM, Wade DT, Verbunt JA. Early neurologically-focused follow-up after cardiac arrest improves quality of life at one year: a randomised controlled trial. Int J Cardiol. 2015;193:8–16.
pubmed: 26005166
doi: 10.1016/j.ijcard.2015.04.229
Sabedra AR, Kristan J, Raina K, Holm MB, Callaway CW, Guyette FX, Dezfulian C, Doshi AA, Rittenberger JC. Neurocognitive outcomes following successful resuscitation from cardiac arrest. Resuscitation. 2015;90:67–72.
pubmed: 25737082
pmcid: 4404201
doi: 10.1016/j.resuscitation.2015.02.023
Ritchie SJ, Tucker-Drob EM. How much does education improve intelligence? A meta-analysis. Psychol Sci. 2018;29(8):1358–69.
pubmed: 29911926
pmcid: 6088505
doi: 10.1177/0956797618774253
Blennow Nordstrom E, Lilja G. Assessment of neurocognitive function after cardiac arrest. Curr Opin Crit Care. 2019;25(3):234–9.
pubmed: 31022085
doi: 10.1097/MCC.0000000000000607