BACKGROUND: A range of neuro-cognitive sequelae, from mild intellectual impairments to brain death, have been reported in survivors of aborted sudden cardiac death. PURPOSE: To determine to what extent, if any, factors associated with cardiopulmonary resuscitation, left ventricular function, and mood state are related to outcomes in five cognitive areas, namely orientation, attention, memory, reasoning, and motor performance. METHODS: Repeated measures were used to assess cognitive outcomes in 45 sudden cardiac arrest survivors over the 6 months following cardiopulmonary resuscitation. A battery of neuro-psychological tests was used to assess cognitive outcomes and psychological status over time. The relationship of the cardiopulmonary resuscitation, left ventricular function, and psychological variables to cognitive outcomes were assessed at each data point. The independent variables included time to cardiopulmonary resuscitation, time to defibrillation, duration of cardiopulmonary resuscitation, time to awakening, ejection fraction, New York Heart Association Class I to IV, tension, anger, and depression. RESULTS: During hospitalization 38 of the 45 survivors (84%) had mild to severe deficits in one or more cognitive areas; 19 of 38 survivors (50%) continued to be impaired in one or more cognitive areas at 6 months. Of these, all had mild to severe deficits in at least one aspect of memory, with delayed recall the most frequent impairment. Time to awakening accounted for a unique portion of the variance in orientation and memory outcomes over time. The left ventricular function variables accounted for a significant portion of the variance in motor speed. CONCLUSIONS: Our results suggest that half of the long-term survivors of aborted sudden cardiac death are cognitively intact 6 months after resuscitation but that 25% have moderate to severe impairment in memory, which could hamper and/or preclude the resumption of prearrest roles.
BACKGROUND: Although anecdotal data suggest that spouses of aborted sudden cardiac death survivors become enmeshed in the physical and emotional recovery of their mates, few longitudinal studies address the personal struggle of aborted sudden cardiac death survivors and their spouses during recovery. OBJECTIVE: To identify and explore phenomena experienced by aborted sudden cardiac death survivors and their spouses, and to determine implications for care. METHODS: This was a phenomenological study; qualitative interviews were conducted within 3 weeks of aborted sudden cardiac death and continued through 24 weeks after arrest at 6- to 8-week intervals. A total of 180 interviews were conducted with 40 survivors and 30 spouses. Interviews were tape-recorded, transcribed, and analyzed for recurrent themes. RESULTS: For the spouses the point of focus, or reference point, for future decision making was the arrest; for the survivors the reference point was prearrest life. These different reference points led to different concerns between spouses and survivors, from which spousal protectiveness and entrapment emerged. CONCLUSIONS: Acknowledgment of different reference points is essential in planning interventions for aborted sudden cardiac death survivors and their spouses. This population must be encouraged to express their questions, concerns, and fears early. Differences in perspectives should be identified to avoid troubled communication and conflicts.