TY - JOUR
T1 - Prognosis After Cardiac Arrest
T2 - The Additional Value of DWI and FLAIR to EEG
AU - Keijzer, Hanneke M.
AU - Verhulst, Marlous M.L.H.
AU - Meijer, Frederick J.A.
AU - Tonino, Bart A.R.
AU - Bosch, Frank H.
AU - Klijn, Catharina J.M.
AU - Hoedemaekers, Cornelia W.E.
AU - Hofmeijer, Jeannette
N1 - Funding Information:
HMK is funded by the Rijnstate-Radboud promotion fund. CJMK is supported by a clinical established investigator grant of the Dutch Heart Foundation (Grant Number 2012T077) and an ASPASIA grant from The Netherlands Organization for Health Research and Development, ZonMw (Grant Number 015008048). JH is supported by a clinical established investigator grant of the Dutch Heart Foundation (Grant Number 2018T070).
Publisher Copyright:
© 2022, Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: Despite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest. Methods: We performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals. Continuous EEG was recorded during the first 3 days and MRI was performed at 3 ± 1 days after cardiac arrest. EEG at 24 h and ischemic damage in 21 predefined brain regions on diffusion weighted imaging and fluid-attenuated inversion recovery on a scale from 0 to 4 were related to outcome. Quantitative MRI analyses included mean apparent diffusion coefficient (ADC) and percentage of brain volume with ADC < 450 × 10−6 mm2/s, < 550 × 10−6 mm2/s, and < 650 × 10−6 mm2/s. Poor outcome was defined as a Cerebral Performance Category score of 3–5 at 6 months. Results: We included 50 patients, of whom 20 (40%) demonstrated poor outcome. Visual EEG assessment correctly identified 3 (15%) with poor outcome and 15 (50%) with good outcome. Visual grading of MRI identified 13 (65%) with poor outcome and 25 (89%) with good outcome. ADC analysis identified 11 (55%) with poor outcome and 3 (11%) with good outcome. EEG and MRI combined could predict poor outcome in 16 (80%) patients at 100% specificity, and good outcome in 24 (80%) at 63% specificity. Ischemic damage was most prominent in the cortical gray matter (75% vs. 7%) and deep gray nuclei (45% vs. 3%) in patients with poor versus good outcome. Conclusions: Magnetic resonance imaging is complementary with EEG for the prediction of poor and good outcome of patients after cardiac arrest who are comatose at admission.
AB - Background: Despite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest. Methods: We performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals. Continuous EEG was recorded during the first 3 days and MRI was performed at 3 ± 1 days after cardiac arrest. EEG at 24 h and ischemic damage in 21 predefined brain regions on diffusion weighted imaging and fluid-attenuated inversion recovery on a scale from 0 to 4 were related to outcome. Quantitative MRI analyses included mean apparent diffusion coefficient (ADC) and percentage of brain volume with ADC < 450 × 10−6 mm2/s, < 550 × 10−6 mm2/s, and < 650 × 10−6 mm2/s. Poor outcome was defined as a Cerebral Performance Category score of 3–5 at 6 months. Results: We included 50 patients, of whom 20 (40%) demonstrated poor outcome. Visual EEG assessment correctly identified 3 (15%) with poor outcome and 15 (50%) with good outcome. Visual grading of MRI identified 13 (65%) with poor outcome and 25 (89%) with good outcome. ADC analysis identified 11 (55%) with poor outcome and 3 (11%) with good outcome. EEG and MRI combined could predict poor outcome in 16 (80%) patients at 100% specificity, and good outcome in 24 (80%) at 63% specificity. Ischemic damage was most prominent in the cortical gray matter (75% vs. 7%) and deep gray nuclei (45% vs. 3%) in patients with poor versus good outcome. Conclusions: Magnetic resonance imaging is complementary with EEG for the prediction of poor and good outcome of patients after cardiac arrest who are comatose at admission.
KW - Cardiac arrest
KW - Diffusion weighted imaging
KW - Electroencephalography
KW - Magnetic resonance imaging
KW - Postanoxic coma
KW - Prognostication
KW - 22/3 OA procedure
UR - http://www.scopus.com/inward/record.url?scp=85128733946&partnerID=8YFLogxK
U2 - 10.1007/s12028-022-01498-z
DO - 10.1007/s12028-022-01498-z
M3 - Article
AN - SCOPUS:85128733946
SN - 1541-6933
VL - 37
SP - 302
EP - 313
JO - Neurocritical care
JF - Neurocritical care
ER -
