Cognitive function after cardiac arrest and temperature management; rationale and description of a sub-study in the Target Temperature Management trial

Gisela Lilja, Niklas Nielsen, Hans Friberg, Janneke Horn, Jesper Kjaergaard, Tommaso Pellis, Malin Rundgren, Jørn Wetterslev, Matt P Wise, Fredrik Nilsson, Tobias Cronberg, Gisela Lilja, Niklas Nielsen, Hans Friberg, Janneke Horn, Jesper Kjaergaard, Tommaso Pellis, Malin Rundgren, Jørn Wetterslev, Matt P Wise, Fredrik Nilsson, Tobias Cronberg

Abstract

Background: Mild to moderate cognitive impairment is common amongst long-term survivors of cardiac arrest. In the Target Temperature Management trial (TTM-trial) comatose survivors were randomized to 33°C or 36°C temperature control for 24 hours after cardiac arrest and the effects on survival and neurological outcome assessed. This protocol describes a sub-study of the TTM-trial investigating cognitive dysfunction and its consequences for patients' and relatives' daily life.

Methods/design: Sub-study sites in five European countries included surviving TTM patients 180 days after cardiac arrest. In addition to the instruments for neurological function used in the main trial, sub-study patients were specifically tested for difficulties with memory (Rivermead Behavioural Memory Test), attention (Symbol Digit Modalities Test) and executive function (Frontal Assessment Battery). Cognitive impairments will be related to the patients' degree of participation in society (Mayo-Portland Adaptability Inventory-4), health related quality of life (Short Form Questionnaire-36v2©), and the caregivers' situation (Zarit Burden Interview©). The two intervention groups (33°C and 36°C) will be compared with a group of myocardial infarction controls.

Discussion: This large international sub-study of a randomized controlled trial will focus on mild to moderate cognitive impairment and its consequences for cardiac arrest survivors and their caregivers. By using an additional battery of tests we may be able to detect more subtle differences in cognitive function between the two intervention groups than identified in the main study. The results of the study could be used to develop a relevant screening model for cognitive dysfunction after cardiac arrest.

Trial registration: ClinicalTrials.gov: NCT01946932.

Figures

Figure 1
Figure 1
Predicted study inclusion in main trial, sub-study and control group.
Figure 2
Figure 2
Two simple questions (TSQ).

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