Neuropsychological and neurological sequelae of out-of-hospital cardiac arrest and the estimated need for neurorehabilitation: a prospective pilot study.

BACKGROUND: Diffuse brain injury is a key component of post-cardiac arrest syndrome reported in 30-80% of survivors of out-of-hospital cardiac arrest (OHCA). It is responsible for a high mortality rate, and is a common cause of cognitive and neurological deficits and disability. Symptom variability and dynamics and the rehabilitation potential remain poorly understood. AIM: To investigate symptom prevalence, type, and severity and the natural course of recovery within 12 months after OHCA, and to estimate neurorehabilitation needs. METHODS: Study participants were selected from OHCA survivors admitted consecutively to a cardiac intensive care unit (CICU) serving 250,000 of Warsaw's inhabitants, according to the following inclusion criteria: first ever nontraumatic, normothermic cardiac arrest, age ≤ 75 years; cardiology ward survival until discharge, and no history of pre-existing brain disease. Patients' cognitive and neurological status and disability were evaluated in the first days after onset and three, six and 12 months later. Neuropsychological assessment focused on attention, memory, executive, linguistic and visuo-spatial abilities. Neurological examination included assessment of cranial nerves, muscle strength and tone, deep tendon reflexes, cerebellar function, sensory function, and gait. The general psychophysical state was classified using the Disability Rating Scale. Patients' neurorehabilitation needs were determined using data collected three months post-OHCA. This data was used to estimate future demands for such resources in Poland. RESULTS: During a 28-month study period, of 69 OHCA patients admitted to the CICU, 29 met the study criteria (33 survived until discharge from cardiology unit; four did not meet further criteria). Severe consciousness disorders were most frequent in the early post-OHCA phase (28%); no unresponsive patients were identified 12 months later. Of responsive patients who were capable of at least minimal co-operation, 100% (early after OHCA) to 57% (12 months after OHCA) had cognitive impairment, usually with neurological symptoms. Memory impairment was the most common and severe problem, followed by executive, attentional, language and visuo-spatial dysfunctions. The prevalence of neurological deficits ranged from 88% (early after OHCA) to 43% (12 months after OHCA). Due to acquired deficits, between 71% (early post-OHCA) and 36% (12 months post-OHCA) of patients were significantly disabled and often dependent. Although dysfunctions tended to improve, over 50% of the patients remained impaired 12 months post-OHCA, and over 30% were significantly disabled. We estimated that about 800 OHCA survivors/year in Poland will develop symptoms requiring neurorehabilitation. CONCLUSIONS: Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.

Pharmacotherapy prior to and in acute ischaemic stroke. The use of pharmacotherapy and drug-associated outcomes in real world practice - findings from the Polish Hospital Stroke Registry.

BACKGROUND AND PURPOSE: Stroke is a preventable disease and acute ischaemic stroke can be effectively treated. Specific pharmacotherapy is recommended in either prevention or acute ischemic stroke treatment. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute ischaemic stroke in a real world practice. MATERIAL AND METHODS: Ischaemic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, web-based questionnaire with authorized access. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute ischaemic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. RESULTS: A total number of 26 153 ischaemic stroke patients (mean age: 71.8 years; females: 51.6%) was reported. The ana-lysis of pharmacotherapy showed that preventive use of hypo-tensive agents, anticoagulants in atrial fibrillation, antiplatelets and statins is inadequate. Regression models confirmed some expected drug benefits and additionally revealed that antihypertensive drugs or aspirin used prior to stroke and oral anticoagulants or statins used in hospital were associated with better stroke outcome. CONCLUSIONS: The prevention of ischaemic stroke needs to be monitored and improved. Evidence-based treatment of acute ischaemic stroke requires further promotion. The benefits of acute ischaemic stroke treatment with statins require to be confirmed in randomized controlled settings.

Pharmacotherapy prior to and in acute haemorrhagic stroke. The use of pharmacotherapy and drugs associated outcomes in real-world practice - findings from the Polish Hospital Stroke Registry.

BACKGROUND AND PURPOSE: Haemorrhagic stroke is associated with substantial mortality and disability, thus prevention and appropriate treatment of acute intracerebral haemorrhage is crucial. We aimed to evaluate the use and the early and late outcomes impact of drugs administered before and in acute haemorrhagic stroke in a real-world practice. MATERIAL AND METHODS: Haemorrhagic stroke patients hospitalized between 1st March 2007 and 29th February 2008 and reported in Polish Hospital Stroke Registry were analysed. Fully anonymous data were collected with standardized, authorized access, web-based questionnaire. Multivariate regression models were used to adjust for case-mix and evaluate the impact of drugs used prior to or in acute haemorrhagic stroke on outcomes. The early outcomes were defined as in-hospital mortality or poor outcome (death or dependency - modified Rankin Scale  3) at hospital discharge, while late outcomes covered one-year survival. RESULTS: A total of 3111 haemorrhagic stroke patients (mean age: 68.9 years; females: 46.7%) was reported. The analysis of pharmacotherapy showed low preventive use of hypotensive agents in hypertensive patients, high consumption of antibiotics and still overuse of vasoactive or neuroprotective compounds in acute haemorrhagic stroke. Regression models confirmed expected negative impact on stroke outcomes associated with oral anticoagulants but not antiplatelets and inconsistent impact of statins used prior to or in acute haemorrhagic stroke. CONCLUSIONS: Preventive underuse of hypotensive compounds contribute substantially to haemorrhagic stroke risk. The high consumption of antibiotics and neuroprotective or vasoactive compounds in haemorrhagic acute stroke reflect the need to improved quality and evidence-based clinical practice.