Monitoring
The ongoing care of patients who achieve return of spontaneous circulation after sudden cardiac arrest is directed at uncovering and addressing the underlying etiology for the arrest, and minimizing the risk of recurrence. In a broad sense, routine care involves the modification of risk factors for atherosclerotic coronary vascular disease (hypertension, hypercholesterolemia, etc.), as well as imaging, electrophysiologic studies, or genetic testing, to determine appropriate candidates for invasive therapy. Specific recommendations for follow-up testing and treatment are particular to each underlying disease process.
Cardiac arrest survivors should be followed up within 3 months of hospital discharge.[95] This assessment should include cognitive screening, screening for emotional problems and fatigue, and the provision of information and support for patients and their family. To screen for cognition, the patient can be asked about common cognitive complaints, such as memory problems, attention difficulties, distractibility, slowness in thinking, irritability, and problems in initiation, planning, multitasking, or flexibility. Family members can also provide useful collateral history about changes in cognition and behavior; a structured questionnaire, such as the Informant Questionnaire of Cognitive decline in the Elderly Cardiac Arrest version (IQCODE-CA) or the Checklist Cognition and Emotion (CLCE-24), may be used. Formal cognitive screening is recommended because patients are not always aware of their cognitive impairments; European guidelines recommend the Montreal Cognitive Assessment (MoCA) tool, which takes approximately 10 min to administer, is easy to use and available in many languages. MoCA Cognition: montreal cognitive assessment (MoCA) tool Opens in new window If there are signs of cognitive impairment, referral to a neuropsychologist for more extensive neuropsychologic assessment, or another specialist in cognitive rehabilitation, such as an occupational therapist, should be considered.[95]
To screen for emotional problems, patients should be asked about the presence of psychological symptoms, including symptoms of anxiety, depression and post-traumatic stress. Questionnaires such as the Hospital Anxiety and Depression Scale (HADS) may be useful. If severe emotional problems are detected, referral to a psychologist or psychiatrist for further evaluation and treatment is recommended.[95]
Patients should be asked if they are experiencing fatigue. In case of severe fatigue, referral to a specialist in rehabilitation medication should be considered.[95]
Patients and their family should be provided with information about cardiac disease, risk factors, medication and ICDs, as well as potential physical, cognitive and emotional changes and fatigue, resuming daily activities, driving, work, and relationships and sex. It is also important to monitor the well-being of family members; partners, especially women and those who witnessed the resuscitation, often experience emotional problems, including symptoms of anxiety, and post-traumatic stress. Referral to a social worker, psychologist, or psychiatrist may be helpful.[95]
Use of this content is subject to our disclaimer