Long-term neuropsychological outcomes in children and adolescents after cardiac arrest

Abstract

Purpose: Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to assess long-term neuropsychological functioning in children and adolescents surviving CA.

Methods: Neuropsychological follow-up study involving all consecutive children surviving CA between January 2002 and December 2011. Intelligence (IQ), language, attention, memory, visual-spatial, and executive functioning were assessed with internationally validated, neuropsychological tests and questionnaires. Scores were compared with Dutch normative data.

Results: Of 107 eligible children, 47 who visited the outpatient clinic (median follow-up interval: 5.6 years) were analyzed. Fifty-five percent had an in-hospital CA, 86% a non-shockable rhythm, and 49% a respiratory-related etiology. CA survivors scored significantly worse on full-scale IQ (mean = 87.3), verbal IQ (mean = 92.7), performance IQ (mean = 85.6), verbal comprehension index (mean = 93.4), perceptual organization index (mean = 83.8), and processing speed index (mean = 91.1), than the norm population (mean IQ = 100). On neuropsychological tests, compared with norms, respectively adjusted for IQ, significantly worse scores were found on visual memory, significantly better on verbal memory (recognition), and comparable outcomes on visual-motor integration, attention, other measures of verbal memory, and executive functioning. On questionnaires, parents reported better executive functioning than the norm, but teachers reported more problems in planning/organizing skills.

Conclusions: Long-term neuropsychological assessment of CA survivors showed significant weaknesses, but also relatively intact functioning. As deficits in IQ, memory and executive functioning have significant impact on the child, long-term follow-up and neuropsychological support of CA survivors is warranted.

Fig. 1

Flowchart of patient inclusion. Lost to follow-up: moved abroad n = 7, untraceable n = 18. n is the actual number of children tested, or the number of respondents to the questionnaire (BRIEF). Numbers of patients may differ for neuropsychological tests due to different age ranges covered by the different tests (and availability of norm data). Beery VMI Beery developmental test of visual motor integration, BRIEF Behaviour rating inventory of executive function questionnaires, PICU pediatric intensive care unit, PPVT peabody picture vocabulary test, RAVLT Rey’s auditory verbal learning test, ROCF Rey–Osterrieth complex figure test, Stroop stroop color word test, TEA-Ch test of everyday attention for children, TMT trail making test, WAIS Wechsler adult intelligence scale, WISC Wechsler intelligence scale for children, WPPSI Wechsler preschool and primary scale of intelligence

Fig. 2

Results on intelligent tests compared with normative data. *Significantly different from the norm

Fig. 3

Results on neuropsychological tests, adjusted for mean full-scale IQ of CA survivors. *Significantly different from the norm. **Significantly different from what would be expected based on the mean full-scale IQ of CA survivors