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Cardiac arrest etiology and associated cognitive impairment in survivors

Koller, Allison (2020) Cardiac arrest etiology and associated cognitive impairment in survivors. Master's Thesis, University of Pittsburgh. (Unpublished)

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Abstract

Background: Cardiac arrest is a significant public health problem, impacting over 500,000 people in the United States annually. The four major etiologies of arrest are cardiac, respiratory, traumatic, and other/unknown. The objective was to determine the impact of etiology on cognition in cardiac arrest survivors using the Montreal Cognitive Assessment (MOCA).
Hypothesis: Cardiac arrest etiology impacts cognitive exam score, and patient demographics and characteristics modify that relationship.
Methods: A retrospective cohort analysis was performed on all Pittsburgh Post Cardiac Arrest Service (PCAS) patients between 2012 and 2018. Patient data were acquired from the PCAS database and through medical record review. T-tests, linear regression, logistic regression, and tests of variance were used to assess the relationships between cognitive exam score and modifying factors. MOCA score was analyzed as a continuous percent score and as a binomial indicator of normal cognition. For all statistical tests, an alpha level of 0.05 was used to determine significance.
Results: MOCA score as a continuous measure was not significantly associated with etiology. When MOCA score was converted to a binomial indicator of normal cognition, respiratory, traumatic, and other/unknown etiologies performed significantly worse than cardiac etiology arrest when age, sex, witnessed status, length of ICU stay and coma were controlled for. These findings were nullified when time from arrest to MOCA administration was introduced to the regression model.
Conclusions: Respiratory, traumatic, and other/unknown etiologies were more likely to exhibit abnormal cognition on the MOCA than those with a cardiac etiology. The etiological findings were nullified when time to cognitive examination was controlled for. Timing appears to be more influential on cognitive performance than cardiac arrest etiology.
Public Health Significance: Survivors struggled with delayed recall regardless of etiology, and respiratory arrests had increased odds of impaired language and attention. This study supports the use of the MOCA serially to assess the impact of timing on cognitive performance after cardiac arrest. Knowledge that timing of exam can impact score more than etiology and that scores improve over time will improve the focus of healthcare and rehabilitation for survivors prior to hospital discharge and in the months of recovery afterward.


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Details

Item Type: University of Pittsburgh ETD
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Koller, Allisonack40@pitt.eduack40
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis AdvisorSonger, Thomastjs@pitt.edu
Committee MemberRittenberger, Jonjcrst19@pitt.edu
Committee ChairRosso, Andreaalr143@pitt.edu
Date: 29 January 2020
Date Type: Publication
Defense Date: 5 December 2019
Approval Date: 29 January 2020
Submission Date: 20 November 2019
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 62
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Epidemiology
Degree: MS - Master of Science
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: cardiac arrest; Montreal Cognitive Assessment (MOCA)
Date Deposited: 29 Jan 2020 19:54
Last Modified: 29 Jan 2020 19:54
URI: http://d-scholarship.pitt.edu/id/eprint/37850

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