Long Term Psychological and Cognitive Effects of Surviving A Cardiac Arrest
It is now widely recognised that severe mental reactions may occur in response to a stressful event and having a cardiac arrest may be emotionally stressful for those who have survived. Furthermore since many patients who have survived a cardiac arrest may be left with a degree of brain injury, moderate to severe neuropsychological sequelae have been found in approximately 50% of cardiac arrest survivors after one year. Although relatively few studies have addressed the long term psychological effects of surviving a cardiac arrest, the research that has been carried out has demonstrated that most cardiac arrest survivors have enjoyed a good overall quality of life but may suffer from a degree of cognitive and emotional impairments. It is not clear whether those who have had a near death experience during their cardiac arrest are protected against these cognitive and emotional impairments as there has never been any studies carried out that have addressed this issue.
Quality of life after cardiac arrest
A European study carried out on survivors of cardiac arrests, which specifically address the issue of quality of life after 6 months of survival have concluded that there were no differences between those who survived a cardiac arrest and those who are discharged from the intensive care unit with other illnesses in terms of quality of life. The authors have commented that ‘these results agree with previous reports stating that cardiopulmonary resuscitation is frequently unsuccessful but if survival is achieved a fairly good quality of life can be expected’.
Other research has been carried out to examine the long term prevalent and emotional disability in cardiac arrest survivors. These have demonstrated that cardiac arrest survivors do not have higher levels of emotional instability or higher levels of anxiety then people who have suffered other medical conditions such as angina, however cardiac arrest survivors have demonstrated some impairment in concentration ability. Some cardiac arrest survivors have also experienced post traumatic stress disorder and that in this sub group there are higher levels of depression and anxiety. Post traumatic stress disorder has been found in up to 27% of cardiac arrest survivors.
Other studies have also shown that there may be long term memory impairment in approximately 20-50% of cardiac arrest survivors which in many cases involves the ability to recall rather than recognition memory. Studies have demonstrated that the memory deficits that take place after a cardiac arrest are persistent and vocal and that cognitive impairment is a serious and under diagnosed complication of prolonged cardiac arrest which effects normal living activities of cardiac arrest survivors.
Long term psychological care of cardiac arrest survivors
Although the study of cognition and consciousness during cardiac arrest as well as the longer term psychological outcomes of surviving a cardiac arrest is a relatively new area of study, significant advances have been made in this field in the last decade. It has been demonstrated that many cardiac arrest survivors may have cognitive processes during the time of their arrest and anecdotally some have also been able to describe accurately verified events during their arrest, indicating the presence of consciousness. Near death experiences appear to have a long term protective psychological effect, even though many studies have shown that a significant proportion of cardiac arrest survivors may suffer from behavioural, cognitive and emotional disturbances that may begin soon after the cardiac arrest and persist for many years. More work is needed to identify ways of preventing and treating these impairments in cardiac arrest survivors.
To date there are no standardised programmes for the long term psychological care of cardiac arrest survivors. However, as recent studies have indicated that many patients who have undergone a cardiac arrest may have long term psychological outcomes, care should be focused on identifying an appropriately managing patients following cardiac arrest.