Regional Distribution of Brain Injury After Cardiac Arrest: Clinical and Electrographic Correlates

Neurology ◽  
2022 ◽  
pp. 10.1212/WNL.0000000000013301
Author(s):  
Samuel B Snider ◽  
David Fischer ◽  
Morgan E McKeown ◽  
Alexander Li Cohen ◽  
Frederic L.W.V.J. Schaper ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Diffusion Mri ◽  
Disorders Of Consciousness ◽  
Outcome Variable ◽  
Background Suppression ◽  
Whole Brain ◽  
Anoxic Brain Injury ◽  
Occipital Lobes ◽  
Regional Associations

Background and Objectives:Disorders of consciousness, EEG background suppression and epileptic seizures are associated with poor outcome after cardiac arrest. Our objective was to identify the distribution of diffusion MRI-measured anoxic brain injury after cardiac arrest and to define the regional correlates of disorders of consciousness, EEG background suppression, and seizures.Methods:We analyzed patients from a single-center database of unresponsive patients who underwent diffusion MRI following cardiac arrest (n=204). We classified each patient based on recovery of consciousness (command-following) before discharge, the most continuous EEG background (burst suppression versus continuous), and the presence or absence of seizures. Anoxic brain injury was measured using the apparent diffusion coefficient (ADC) signal. We identified ADC abnormalities relative to control subjects without cardiac arrest (n=48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each outcome variable. Finally, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures.Results:Compared to controls, cardiac arrest patients demonstrated ADC signal reduction most significant in the occipital lobes. Disorders of consciousness were associated with reduced ADC most prominently in the occipital lobes, but also in deep structures. Regional injury more accurately classified patients with disorders of consciousness than whole-brain injury. Background suppression mapped to a similar set of brain regions, but regional injury could no better classify patients than whole-brain measures. Seizures were less common in patients with more severe anoxic injury, particularly in those with injury to the lateral temporal white matter.Discussion:Anoxic brain injury was most prevalent in posterior cerebral regions, and this regional pattern of injury was a better predictor of disorders of consciousness than whole-brain injury measures. EEG background suppression lacked a specific regional association, but patients with injury to the temporal lobe were less likely to have seizures. Regional patterns of anoxic brain injury are relevant to the clinical and electrographic sequelae of cardiac arrest and may hold importance for prognosis.Classification of Evidence:This study provides Class IV evidence that disorders of consciousness after cardiac arrest are associated with widely lower ADC values on diffusion MRI and are most strongly associated with reductions in occipital ADC.

scholarly journals Regional distribution of anoxic brain injury after cardiac arrest: clinical and electrographic correlates

2021 ◽  
Author(s):  
Samuel Snider ◽  
David Fischer ◽  
Morgan E McKeown ◽  
Alexander Li Cohen ◽  
Frederic Schaper ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Disorders Of Consciousness ◽  
Background Suppression ◽  
Regional Pattern ◽  
Whole Brain ◽  
Anoxic Brain Injury ◽  
Control Subjects ◽  
Occipital Lobes ◽  
Regional Associations

Introduction Disorders of consciousness, EEG background suppression and epileptic seizures are associated with poor outcome after cardiac arrest. The underlying patterns of anoxic brain injury associated with each remain unknown. Our objective was to identify the distribution of anoxic brain injury after cardiac arrest, as measured with diffusion MRI, and to define the regional correlates of disorders of consciousness, EEG background suppression, and seizures. Methods We analyzed patients from a prospectively-maintained, single-center database of unresponsive patients who underwent diffusion-weighted MRI following cardiac arrest (n = 204). We classified each patient based on recovery of consciousness (command-following) before discharge, the most continuous EEG background (burst suppression versus continuous), and the presence or absence of seizures. Anoxic brain injury was measured using the apparent diffusion coefficient (ADC) signal. We identified abnormalities in ADC relative to control subjects without cardiac arrest (n = 48) and used voxel lesion symptom mapping to identify regional associations with disorders of consciousness, EEG background suppression, and seizures. We then used a bootstrapped lasso regression procedure to identify robust, multivariate regional associations with each clinical and EEG variable. Finally, using area under receiver operating characteristic curves, we then compared the classification ability of the strongest regional associations to that of brain-wide summary measures. Results Compared to control subjects, cardiac arrest patients demonstrated a reduction in the ADC signal that was most significant in the occipital lobes. Disorders of consciousness were associated with reduced ADC most prominently in the occipital lobes, but also in the basal ganglia, medial thalamus and cerebellar nuclei. Regional injury more accurately classified patients with disorders of consciousness than whole-brain injury. Background suppression mapped to a similar set of brain regions, but regional injury could no better classify patients than whole-brain measures. Seizures were less common in patients with more severe anoxic injury, particularly in those with injury to the lateral temporal white matter. Discussion Anoxic brain injury was most prevalent in posterior cerebral regions, and this regional pattern of injury was a better predictor of disorders of consciousness than whole-brain injury measures. EEG background suppression lacked a specific regional association, but patients with injury to the temporal lobe were less likely to have seizures. Collectively, our results suggest that the regional pattern of anoxic brain injury is relevant to the clinical and electrographic sequelae of cardiac arrest and may hold importance for prognosis.

scholarly journals Trends, Predictors and Outcomes After Utilization of Targeted Temperature Management in Cardiac Arrest Patients With Anoxic Brain Injury

2020 ◽  
Vol 360 (4) ◽  
pp. 363-371
Author(s):  
Muhammad Zia Khan ◽  
Muhammad U. Khan ◽  
Kinjan Patel ◽  
Safi U. Khan ◽  
Shahul Valavoor ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Anoxic Brain Injury

scholarly journals Cerebral autoregulation in anoxic brain injury patients treated with targeted temperature management

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ilaria Alice Crippa ◽  
Jean-Louis Vincent ◽  
Federica Zama Cavicchi ◽  
Selene Pozzebon ◽  
Filippo Annoni ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Body Temperature ◽  
Hospital Discharge ◽  
Core Body Temperature ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Anoxic Brain Injury ◽  
Shockable Rhythm ◽  
Core Body

Abstract Background Little is known about the prevalence of altered CAR in anoxic brain injury and the association with patients’ outcome. We aimed at investigating CAR in cardiac arrest survivors treated by targeted temperature management and its association to outcome. Methods Retrospective analysis of prospectively collected data. Inclusion criteria: adult cardiac arrest survivors treated by targeted temperature management (TTM). Exclusion criteria: trauma; sepsis, intoxication; acute intra-cranial disease; history of supra-aortic vascular disease; severe hemodynamic instability; cardiac output mechanical support; arterial carbon dioxide partial pressure (PaCO2) > 60 mmHg; arrhythmias; lack of acoustic window. Middle cerebral artery flow velocitiy (FV) was assessed by transcranial Doppler (TCD) once during hypothermia (HT) and once during normothermia (NT). FV and blood pressure (BP) were recorded simultaneously and Mxa calculated (MATLAB). Mxa is the Pearson correlation coefficient between FV and BP. Mxa > 0.3 defined altered CAR. Survival was assessed at hospital discharge. Cerebral Performance Category (CPC) 3–5 assessed 3 months after CA defined unfavorable neurological outcome (UO). Results We included 50 patients (Jan 2015–Dec 2018). All patients had out-of-hospital cardiac arrest, 24 (48%) had initial shockable rhythm. Time to return of spontaneous circulation was 20 [10–35] min. HT (core body temperature 33.7 [33.2–34] °C) lasted for 24 [23–28] h, followed by rewarming and NT (core body temperature: 36.9 [36.6–37.4] °C). Thirty-one (62%) patients did not survive at hospital discharge and 36 (72%) had UO. Mxa was lower during HT than during NT (0.33 [0.11–0.58] vs. 0.58 [0.30–0.83]; p = 0.03). During HT, Mxa did not differ between outcome groups. During NT, Mxa was higher in patients with UO than others (0.63 [0.43–0.83] vs. 0.31 [− 0.01–0.67]; p = 0.03). Mxa differed among CPC values at NT (p = 0.03). Specifically, CPC 2 group had lower Mxa than CPC 3 and 5 groups. At multivariate analysis, initial non-shockable rhythm, high Mxa during NT and highly malignant electroencephalography pattern (HMp) were associated with in-hospital mortality; high Mxa during NT and HMp were associated with UO. Conclusions CAR is frequently altered in cardiac arrest survivors treated by TTM. Altered CAR during normothermia was independently associated with poor outcome.

Poster 390 Choreoathetoid Movement Disorder Following Anoxic Brain Injury Due to Cardiac Arrest: A Case Report

PM&R ◽  
2014 ◽  
Vol 6 (9) ◽  
pp. S322
Author(s):  
Elizabeth Martin ◽  
Neal Varghis ◽  
Jeffrey Englander ◽  
Roberta Y. Wang
Keyword(s):  
Cardiac Arrest ◽  
Case Report ◽  
Brain Injury ◽  
Movement Disorder ◽  
Anoxic Brain Injury

scholarly journals Dynamic regimes of neocortical activity linked to corticothalamic integrity correlate with outcomes in acute anoxic brain injury after cardiac arrest

2017 ◽  
Vol 4 (2) ◽  
pp. 119-129 ◽  
Author(s):  
Peter B. Forgacs ◽  
Hans-Peter Frey ◽  
Angela Velazquez ◽  
Stephanie Thompson ◽  
Daniel Brodie ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Anoxic Brain Injury

Poster 86: Disorders of Consciousness due to Anoxic Brain Injury: A Case Series of 8 Patients

PM&R ◽  
2017 ◽  
Vol 9 ◽  
pp. S164-S164
Author(s):  
Mark A. Linsenmeyer ◽  
Shanti M. Pinto ◽  
Gary N. Galang
Keyword(s):  
Brain Injury ◽  
Case Series ◽  
Disorders Of Consciousness ◽  
Anoxic Brain Injury

Abstract 361: The Significance of Higher Mean Arterial Pressure After Inpatient Cardiac Arrests in Improving Neurological Outcome and Mortality

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Manishkumar Patel ◽  
Sourabh Sourabh ◽  
Victoria Gonzalez ◽  
Ankita Aggarwal ◽  
Fred Bittner ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Mean Arterial Pressure ◽  
Arterial Pressure ◽  
Sample Size ◽  
Small Sample Size ◽  
Small Sample ◽  
Inclusion Criteria ◽  
Anoxic Brain Injury ◽  
Significant Difference

Following cardiac arrest and the return of spontaneous circulation (ROSC), hemodynamic status can be critically unstable which may lead to the hypoperfusion of vital organs and poor clinical outcomes. In post-cardiac arrest survivors, studies have shown improved outcomes with a higher mean arterial pressure (MAP) compared with a lower MAP, however an ideal range of MAP post-ROSC is rarely explicitly defined in post-resuscitation care studies. The purpose of this study was to observe neurological and mortality outcomes in cardiac arrest patients with a lower range of post-ROSC MAP compared to a higher range of post-ROSC MAP.A retrospective single-center cohort study was used to design the project. Patients who met the inclusion criteria suffered a cardiac arrest while admitted to the hospital, achieved ROSC, and survived for at least 48 hours post-ROSC. Patients whose status was changed to DNR by 48 hours post-ROSC were excluded. The remaining patients were divided into two groups. The lower MAP group had an average MAP of 60 to 80 mmHg and the higher MAP group had an average MAP of 80 to 100 mmHg at 48 hours post-ROSC. The primary outcome analyzed was the presence of anoxic brain injury noted on EEG. Secondary outcomes were the length of intubation, ICU length of stay (LOS), and mortality rate. Of the total of 129 patients, 18 patients met our inclusion criteria. Of these, 10 patients met the lower MAP group and 8 patients met the higher MAP group. Anoxic brain injury was 20% in the lower MAP group compared to 12.5% in the higher MAP group (p>0.05). There was a 40% mortality in the lower MAP group, compared to 12.5% mortality in the higher MAP group (p>0.05) 48 hours post-ROSC. The mean length of intubation was 3.5 days in the higher MAP group compared to 4.9 days in the lower MAP group (p>0.05). There was no difference in the ICU LOS amongst the two groups. Our results showed a clinically significant difference between the two groups but could not reach statistical significance due to the small sample size. The optimal MAP for post-cardiac arrest patients has not been clearly defined by clinical trials. The simultaneous need to perfuse the post-ischemic brain adequately without putting unnecessary strain on the post-ischemic heart is unique to the post-cardiac arrest syndrome. The findings of this study show post-ROSC MAP maintained between 80 to 100 mmHg had a statistically insignificant tendency toward better neurological outcomes, decreased length of intubation and improved mortality compared to the group whose MAP was maintained between 60 to 80 mmHg at 48 hours. The small sample size is a limitation for this study, however, this preliminary study has shown promising results and it is predicted that a bigger population study with similar parameters will extrapolate similar results.

scholarly journals THE AUTONOMIC STORM: A COMPLICATION OF ANOXIC BRAIN INJURY AFTER CARDIAC ARREST

CHEST Journal ◽  
2020 ◽  
Vol 158 (4) ◽  
pp. A988
Author(s):  
Imama Ahmad ◽  
Sneha Lakshman ◽  
Thomas Carr
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Anoxic Brain Injury

scholarly journals Hypothermic modulation of anoxic brain injury in adult survivors of cardiac arrest: a review of the literature and an algorithm for emergency physicians

CJEM ◽  
2005 ◽  
Vol 7 (01) ◽  
pp. 42-47 ◽  
Author(s):  
Robert S. Green ◽  
Daniel Howes
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Treatment Algorithm ◽  
Adult Survivors ◽  
Induced Hypothermia ◽  
Emergency Physicians ◽  
Review Of The Literature ◽  
Anoxic Brain Injury ◽  
Neurological Outcomes ◽  
Canadian Association

ABSTRACT Anoxic brain injury is a common outcome after cardiac arrest. Despite substantial research into the pathophysiology and management of this injury, a beneficial treatment modality has not been previously identified. Recent studies show that induced hypothermia reduces mortality and improves neurological outcomes in patients resuscitated from ventricular fibrillation. This article reviews the literature on induced hypothermia for anoxic brain injury and summarizes a treatment algorithm proposed by the Canadian Association of Emergency Physicians Critical Care Committee for hypothermia induction in cardiac arrest survivors.

Sign in / Sign up

Export Citation Format

Share Document