Cognitive and Psychological Outcomes of Patients 6 Months After Cardiac Arrest or Intensive Care Stay

Background: The neuropsychological and cognitive consequences of an ICU stay can cause a large burden on many patients. In this study, we assessed the outcomes of a group of patients attending a newly set up, multi-disciplinary outpatient clinic focused on assessing neuropsychological and cognitive outcomes following a significant (>72 hours) ICU stay, and compared patients whose ICU was post-OHCA (out of hospital cardiac arrest), and those non-OHCA. Methods: Between 2016 and 2019, 152 patients were assessed within the Care after REsuscitation (CARE) / ICU follow up clinic, 6 months following hospital discharge, using the SF-36, HADS, PTSS-14 and MoCA. The OHCA group were compared to other non-OHCA, ICU patients (>72 hour stay). Results: No significant differences (p<0.05) were found between the groups outcomes, however we found that 6 months post-discharge, the non-OHCA group experience significantly more pain, are older, and required a longer length of stay (p<0.05). However, we found compared to normative data of the SF-36, over half of the OHCA group (on 6 out of the 8 subscales) and the non-OHCA (on 7 out of the 8) were below population norms, especially Role-Physical (66.7% OHCA and 71.6% non-OHCA) and Energy/ fatigue (66.7% OHCA and 61.4% non-OHCA). Anxiety was observed in 33.3% of the OHCA group, and 35.2% of the non-OHCA group had an abnormal total HADS score. PTSD was seen in 12.7% of the OHCA group and 10.2% of the non-OHCA group. Cognitive impairment was observed in 61.9% of OHCA and 59.1% of non-OHCA patients. Age and hospital length of stay had no significant effect on outcomes on our OHCA population, however females had significantly worse health related quality of life (HRQoL) on 6 out of the 8 subscales (p<0.05). Conclusion: Despite the OHCA and non-OHCA groups having no significant difference between their outcomes, there is a great disease burden upon many individuals following ICU stay, with many experiencing poor HRQoL, mood disorders, PTSD and cognitive impairment. The factors contributing to poor outcome following both ICU related illness and cardiac arrest should be further studied. The creation and validation of new assessment tools is imperative to ensure we fully appreciate the extent of the morbidity in this group to improve care for all ICU patients.