Abstract 13082: Region-Specific Diffusion-Weighted Imaging Predicts Neurological Outcome in Comatose Post-Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Wang Pong Chan ◽  
Troy Gallerani ◽  
Caitlyn Keenan ◽  
Darya Musatova ◽  
Katie Dam ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Linear Regression ◽  
Neurological Outcome ◽  
Diffusion Weighted Imaging ◽  
Brain Regions ◽  
Controlled Study ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Diffusion Weighted ◽  
Poor Neurological Outcome

Introduction & Hypothesis: Diffusion-weighted imaging (DWI), a technique sensitive to acute brain ischemia, may hold utility in predicting neurological outcome in comatose post-cardiac arrest patients. Outcome studies are biased by early withdrawal of life sustaining therapy (WLST), leading to a self-fulfilling prophecy. This creates a need to reassess the use of DWI as a neuroprognostic tool in patients who have not undergone WLST. We hypothesize that DWI abnormalities is a robust predictor of poor neurological outcome in our WLST - controlled cohort. Methods: We leveraged the MOCHA database, a registry of over 300 comatose post-cardiac arrest patients, to retrospectively examine neurological outcomes in a cohort of patients who did not undergo WLST. A good outcome was defined by a cerebral performance category (CPC) score at discharge of 1 - 3, while a poor outcome CPC 4 - 5 (n=43). We first examined the relationship between the number of brain regions with DWI abnormalities and CPC score using a linear regression. We then examined how DWI abnormalities in specific brain regions correlated with CPC score outcome groups using a fisher exact test. DWI abnormalities were qualitatively determined by two vascular neurologists. Results: We found a positive correlation between the number of brain regions with DWI abnormalities and CPC score ( linear regression , R 2 =0.572, p=2.670x10 -9 ). Interestingly, the association between DWI abnormalities and CPC score exhibited brain region-specific variability. DWI abnormalities exhibited the strongest association with poor neurological outcome in the occipital lobe ( fisher exact test , p=7.413x10 -10 ), parietal lobe (p=9.125x10 -9 ), frontal lobe (p=5.385x10 -9 ), temporal lobe (p=3.904x10 -8 ) and basal ganglia (p=2.342x10 -7 ); and the weakest association in the white matter (p=1.000) and brain stem (p=6.612x10 -2 ). Conclusion: Our preliminary results suggest that the region of ischemia is an important factor to consider in predicting neurological outcome. This warrants a larger scale WLST-controlled study examining region-specific DWI abnormalities and neurological outcome - the findings of which would improve our neuroprognostication capabilities in comatose post-cardiac arrest patients.

NSE as a predictor of death or poor neurological outcome after non-shockable cardiac arrest due to any cause: Ancillary study of HYPERION trial data

Resuscitation ◽  
2021 ◽  
Vol 158 ◽  
pp. 193-200
Author(s):  
Jean-Baptiste Lascarrou ◽  
Arnaud-Félix Miailhe ◽  
Amélie le Gouge ◽  
Alain Cariou ◽  
Pierre-François Dequin ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Trial Data ◽  
Ancillary Study ◽  
Poor Neurological Outcome

Abstract 55: The CAHP (Cardiac Arrest Hospital Prognosis) Score: Predicting Neurological Outcome After Out-of-Hospital Cardiac Arrest

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Carole Maupain ◽  
Wulfran Bougouin ◽  
Lamhaut Lionel ◽  
Nicolas Deye ◽  
Daniel Jost ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
High Risk ◽  
Neurological Outcome ◽  
Risk Group ◽  
Unfavorable Outcome ◽  
Validation Dataset ◽  
Group Score ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest ◽  
Prognosis Score

Background: Out-of-hospital cardiac arrest (OHCA) carries a very poor prognosis. Early prognostication of patients admitted in ICU after resuscitated OHCA is a key issue but remains challenging. The aim of that study was to establish a new scoring system to predict poor neurological outcome in these patients. Materials and Methods: The CAHP (Cardiac Arrest Hospital Prognosis) score was developed from the Sudden Death Expertise Center registry (SDEC, Paris, France). Objective risk factors were weighted on the basis of a logistic regression analysis. The primary outcome was poor neurological outcome defined as Cerebral Performance Category 3, 4 or 5. Thresholds were defined to distinguish low, moderate and high-risk groups. The CAHP score was then validated in an external dataset (Parisian OHCA Registry). Score calibration and discrimination characteristics were assessed in the validation dataset. Results: The developmental dataset included 819 patients admitted in ICU from May 2011 to December 2012. After logistic regression, 7 variables were independently associated with poor neurological outcome: age, initial shockable rhythm, time form collapse to basic life support (BLS), time from BLS to return of spontaneous circulation (ROSC), location of cardiac arrest, epinephrine dose during resuscitation and arterial pH at admission. These variables were included in the CAHP score. 3 risks groups were identified: a low risk group (score ≤ 150, 39 % of unfavorable outcome), medium risk group (score 150-200, 81% of unfavorable outcome) and high-risk group (CAHP score ≥ 200, 100 % of unfavorable outcome). AUC of the CAHP score was 0.93. In the external validation dataset, discrimination value of the CAHP score was consistent with an AUC of 0.85. Conclusion: The CAHP score is a simple and objective tool for early assessment of prognosis in patients admitted to ICU after OHCA. Moreover it allows to stratify the probability of poor neurological outcome by identifying a very high-risk category of patients (score ≥ 200).

scholarly journals A Practical Risk-Score for Early Prediction of Neurological Outcome after Out-of-Hospital Cardiac Arrest –MIRA2CLE2

2020 ◽  
Author(s):  
Nilesh Pareek ◽  
Peter Kordis ◽  
Nicholas Beckley-Hoelscher ◽  
Dominic Pimenta ◽  
Spela Tadel Kocjancic ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Risk Score ◽  
Neurological Outcome ◽  
Heart Attack ◽  
Primary Outcome ◽  
Cerebral Performance Category ◽  
Epinephrine Administration ◽  
Poor Outcome ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

AimsThe purpose of this study was to develop a practical risk−score to predict poor neurological outcome after out−of−hospital cardiac arrest (OOHCA) for use on arrival to a Heart Attack Centre.Methods and ResultsBetween May 2012 and December 2017, 1055 patients had OOHCA in our region, of whom 373 patients were included in the King's Out of Hospital Cardiac Arrest Registry (KOCAR). We performed prediction modelling with multi-variable logistic regression to identify factors independently predictive of the primary outcome in order to derive a risk score. This was externally validated in two independent cohorts comprising 474 patients. The primary outcome was poor neurological function at 6−month follow−up (Cerebral Performance Category 3-−). Seven independent variables for prediction of outcome were identified: Missed (Unwitnessed) arrest, Initial non-shockable rhythm, non-Reactivity of pupils, Age, Changing intra-arrest rhythms, Low pH<;7.20 and Epinephrine administration. From these variables, the MIRA2CLE2 score was developed which had an AUC of 0.90 in the development and 0.85 and 0.89 in the validation cohorts. 3 risk groups of the MIRA2CLE2 were defined − Low risk (≤2−5.6% risk of poor outcome; Intermediate risk (3−4−55.4% of poor outcome) and high risk (≥5−92.3% risk of poor outcome). The risk-score performance was equivalent in a sub-group of patients referred for early angiography and revascularisation where appropriate.ConclusionsThe MIRA2CLE2 score is a practical risk score for early accurate prediction of poor neurological outcome after OOHCA, which has been developed for simplicity of use on admission to a Heart Attack Centre.

Usefulness of the Degree of Blood–brain Barrier Disruption to Predict Neurological Prognosis in Cardiac Arrest Survivors who Wnderwent Target Temperature Management: A Retrospective Study

2020 ◽  
Author(s):  
Ga Ram Jeon ◽  
Hong Joon Ahn ◽  
Jung Soo Park ◽  
Insool Yoo ◽  
Yeonho You ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Blood Brain Barrier ◽  
Neurological Outcome ◽  
Scoring System ◽  
Brain Barrier ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Neurological Outcomes ◽  
Poor Neurological Outcome

Abstract Background: This study aimed to compare the day-specific association of blood–brain barrier (BBB) disruption with neurological outcomes in out-of-hospital cardiac arrest (OHCA) survivors treated with target temperature management (TTM).Methods: This retrospective single-center study included 68 OHCA survivors, who underwent TTM between April 2018 and December 2019. The albumin quotient (QA) was calculated as [albuminCSF] / [albuminserum] immediately (day 1), and at 24 h (day 2), 48 h (day 3), and 72 h (day 4) after return of spontaneous circulation (ROSC). The degree of BBB disruption was weighted using the following scoring system: 0.07 ≥ QA (normal), 0.01 ≥ QA > 0.007 (mild), 0.02 ≥ QA > 0.01 (moderate), and QA > 0.02 (severe). This system gave it 0 (normal), 1 (mild), 4 (moderate), and 9 (severe) points. Poor neurological outcome was determined at six months after ROSC and was defined as cerebral performance categories 3–5.Results: We enrolled 68 patients (males, 48; 71%); 37 (54%) of them had a poor neurological outcome. The distributions of this outcome at six months in patients with moderate and severe BBB disruption versus the other groups were 19/22 (80%) vs. 18/46 (50%) on day 1, 31/37 (79%) vs. 6/31 (32%) on day 2, 32/37 (81%) vs. 5/31 (30%) on day 3, and 32/39 (85%) vs. 5/29 (30%) on day 4 (P < 0.001). Using ROC analyses, the optimal cutoff values of QA levels for prediction of neurological outcomes were determined as: day 1, > 0.009 (sensitivity 56.8%, specificity 87.1%); day 2, > 0.012 (sensitivity 81.1%, specificity 87.1%); day 3, > 0.013 (sensitivity 83.8%, specificity 87.1%); day 4, > 0.013 (sensitivity 86.5%, specificity 87.1%); sum of all time points, > 0.039 (sensitivity 89.5%, specificity 79.4%); and scoring system, > 9 (sensitivity 91.9%, specificity 87.1%). Conclusions: Our results suggested that QA is a useful tool for predicting neurological outcomes in OHCA survivors treated with TTM. However, the prediction of poor neurological outcome using QA showed low sensitivity at 100% specificity. Thus, it could be used as part of a multimodal approach than as a single prognostic prediction tool.

scholarly journals Serum tau fragments as predictors of death or poor neurological outcome after out-of-hospital cardiac arrest

Biomarkers ◽  
2019 ◽  
Vol 24 (6) ◽  
pp. 584-591 ◽  
Author(s):  
Johannes Grand ◽  
Jesper Kjaergaard ◽  
Niklas Nielsen ◽  
Hans Friberg ◽  
Tobias Cronberg ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

scholarly journals Infrared pupillometry to help predict neurological outcome for patients achieving return of spontaneous circulation following cardiac arrest: a systematic review protocol

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Alex Monk ◽  
Shashank Patil
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Objective Measure ◽  
Spontaneous Circulation ◽  
Neurological Injury ◽  
Return Of Spontaneous Circulation ◽  
Use Of Resources ◽  
Infrared Pupillometry ◽  
Poor Neurological Outcome

Abstract Background Despite advances in resuscitation care, mortality rates following cardiac arrest (CA) remain high. Between one-quarter (in-hospital CA) and two-thirds (out of hospital CA) of patients admitted comatose to intensive care die of neurological injury. Neuroprognostication determines an informed and timely withdrawal of life sustaining treatment (WLST), sparing the patient unnecessary suffering, alleviating family distress and allowing a more utilitarian use of resources. The latest Resuscitation Council UK (2015) guidance on post-resuscitation care provides the current multi-modal neuroprognostication strategy to predict neurological outcome. Its modalities include neurological examination, neurophysiological tests, biomarkers and radiology. Despite each of the current strategy’s predictive modalities exhibiting limitations, meta-analyses show that three, namely PLR (pupillary light reflex), CR (corneal reflex) and N20 SSEP (somatosensory-evoked potential), accurately predict poor neurological outcome with low false positive rates. However, the quality of evidence is low, reducing confidence in the strategy’s results. While infrared pupillometry (IRP) is not currently used as a prognostication modality, it can provide a quantitative and objective measure of pupillary size and PLR, giving a definitive view of the second and third cranial nerve activity, a predictor of neurological outcome. Methods The proposed study will test the hypothesis, “in those patients who remain comatose following return of spontaneous circulation (ROSC) after CA, IRP can be used early to help predict poor neurological outcome”. A comprehensive review of the evidence using a PRISMA-P (2015) compliant methodology will be underpinned by systematic searching of electronic databases and the two authors selecting and screening eligible studies using the Cochrane data extraction and assessment template. Randomised controlled trials and retrospective and prospective studies will be included, and the quality and strength of evidence will be assessed using the Grading  of Recommendation, Assessment and Evaluation (GRADE) approach. Discussion IRP requires rudimentary skill and is objective and repeatable. As a clinical prognostication modality, it may be utilised early, when the strategy’s other modalities are not recommended. Corroboration in the evidence would promote early use of IRP and a reduction in ICU bed days. Systematic review registration PROSPERO CRD42018118180

scholarly journals Performance of a guideline-recommended algorithm for prognostication of poor neurological outcome after cardiac arrest

2020 ◽  
Vol 46 (10) ◽  
pp. 1852-1862 ◽  
Author(s):  
Marion Moseby-Knappe ◽  
Erik Westhall ◽  
Sofia Backman ◽  
Niklas Mattsson-Carlgren ◽  
Irina Dragancea ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Poor Neurological Outcome ◽  
Recommended Algorithm

scholarly journals Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

2020 ◽  
Vol 46 (10) ◽  
pp. 1803-1851 ◽  
Author(s):  
Claudio Sandroni ◽  
Sonia D’Arrigo ◽  
Sofia Cacciola ◽  
Cornelia W. E. Hoedemaekers ◽  
Marlijn J. A. Kamps ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiac Arrest ◽  
Neurological Outcome ◽  
Poor Neurological Outcome

scholarly journals Effect of probiotic on innate inflammatory response and viral shedding in experimental rhinovirus infection – a randomised controlled trial

2017 ◽  
Vol 8 (2) ◽  
pp. 207-215 ◽  
Author(s):  
R.B. Turner ◽  
J.A. Woodfolk ◽  
L. Borish ◽  
J.W. Steinke ◽  
J.T. Patrie ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Treated Group ◽  
Subjective Symptom ◽  
Nasal Lavage ◽  
Host Responses ◽  
Controlled Study ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Virus Challenge ◽  
Rhinovirus Infection

Ingestion of probiotics appears to have modest effects on the incidence of viral respiratory infection. The mechanism of these effects is not clear; however, there is evidence from animal models that the probiotic may have an effect on innate immune responses to pathogens. The purpose of this randomised, placebo-controlled study was to determine the effect of administration of Bifidobacterium animalis subspecies lactis Bl-04 on innate and adaptive host responses to experimental rhinovirus challenge. The effect on the response of chemokine (C-X-C motif) ligand 8 (CXCL8) to rhinovirus infection was defined as the primary endpoint for the study. 152 seronegative volunteers who had been supplemented for 28 days, 73 with probiotic and 79 with placebo, were challenged with RV-A39. Supplement or placebo administration was then continued for five days during collection of specimens for assessment of host response, infection, and symptoms. 58 probiotic and 57 placebo-supplemented volunteers met protocol-defined criteria for analysis. Probiotic resulted in higher nasal lavage CXCL8 on day 0 prior to virus challenge (90 vs 58 pg/ml, respectively, P=0.04, ANCOVA). The CXCL8 response to rhinovirus infection in nasal lavage was significantly reduced in the probiotic treated group (P=0.03, ANCOVA). Probiotic was also associated with a reduction in nasal lavage virus titre and the proportion of subjects shedding virus in nasal secretions (76% in the probiotic group, 91% in the placebo group, P=0.04, Fisher Exact test). The administration of probiotic did not influence lower respiratory inflammation (assessed by exhaled nitric oxide), subjective symptom scores, or infection rate. This study demonstrates that ingestion of Bl-04 may have an effect on the baseline state of innate immunity in the nose and on the subsequent response of the human host to rhinovirus infection. Clinicaltrials.gov registry number: NCT01669603.

Sign in / Sign up

Export Citation Format

Share Document