Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Wu, Ona; Sorensen, A. Gregory; Benner, Thomas; Singhal, Aneesh B.; Furie, Karen L.; Greer, David M.

doi:10.1148/radiol.2521081232

Cited by 169 publications

(131 citation statements)

References 31 publications

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“…In these studies, absence of ADC depression or DWI changes was associated with good neurological recovery [61,62]. In two larger studies, lower whole-brain median ADC and the percentage of brain volume with an ADC value below the threshold of 650-700 9 10 -6 mm 2 /s were significant predictors of poor outcome [63,64]. When using ADC depression as a prognosticator in patients who were cooled after CA, it is important to realize that hypothermia per se can cause ADC depression, as was demonstrated in a rat model and a patient study [65,66].…”

Section: Brain Imaging (Ct-scan and Mri)mentioning

confidence: 99%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

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The prognosis of patients who are admitted to the hospital after cardiac arrest often relies on neurological examination, which could be significantly influenced by the use of sedative drugs or the implementation of targeted temperature management. The need for early and accurate prognostication is crucial as up to 15-20% of patients could be considered as having a poor outcome and may undergo withdrawal of life-sustaining therapies while a complete neurological recovery is still possible. As current practice in Belgium is still based on a very early assessment of neurological function in these patients, the Belgian Society of Intensive Care Medicine created a multidisciplinary Task Force to provide an optimal approach for monitoring and refine prognosis of CA survivors. This Task Force underlined the importance to use a multimodal approach using several additional tools (e.g., electrophysiological tests, neuroimaging, biomarkers) and to refer cases with uncertain prognosis to specialized centers to better evaluate the extent of brain injury in these patients.

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Section: Brain Imaging (Ct-scan and Mri)mentioning

confidence: 99%

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Taccone¹,

Colpaert²,

Waele³

et al. 2015

Resuscitation

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“…ADC values between 700 and 800×10 −6 mm 2 /s are considered normal. 335 In 1 study 338 (80 patients; very-low-quality evidence), a whole-brain ADC less than 665×10 −6 mm 2 /s predicted poor outcome, with 0 (0-21)% FPR and 40 (28-53)% sensitivity. In a small subset of another study 293 (10 patients; very-low-quality evidence), presence of more than 10% of brain volume with ADC less than 650×10 −6 mm 2 /s predicted poor outcome, with 88 (47-100)% sensitivity and 0 (0-78)% FPR.…”

Section: Mrimentioning

confidence: 99%

Part 4: Advanced Life Support

Nolan¹,

Hazinski²,

Aickin³

et al. 2015

Circulation

554

125

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Questions to be addressed (using the PICO [population, intervention, comparator, outcome] format) 3 were prioritized by ALS Task Force members (by voting). Prioritization criteria included awareness of significant new data and new controversies or questions about practice. Questions about topics no longer relevant to contemporary practice or where little new research has occurred were given lower priority. The ALS Task Force prioritized 42 PICO questions for review. With the assistance of information specialists, a detailed search for relevant articles was performed in each of 3 online databases (PubMed, Embase, and the Cochrane Library).By using detailed inclusion and exclusion criteria, articles were screened for further evaluation. The reviewers for each question created a reconciled risk of bias assessment for each of the included studies, using state-of-the-art tools: Cochrane for randomized controlled trials (RCTs), 4 Quality Assessment of Diagnostic Accuracy Studies (QUADAS)-2 for studies of diagnostic accuracy, 5 and GRADE for observational studies that inform both therapy and prognosis questions. 6 GRADE evidence profile tables 7 were then created to facilitate an evaluation of the evidence in support of each of the critical and important outcomes. The quality of the evidence (or confidence in the estimate of the effect) was categorized as high, moderate, low, or very low, 8 based on the study methodologies and the 5 core GRADE domains of risk of bias, inconsistency, indirectness, imprecision, and other considerations (including publication bias). 9 These evidence profile tables were then used to create a written summary of evidence for each outcome (the consensus on science statements). Whenever possible, consensus-based treatment recommendations were then created. These recommendations (designated as strong or weak) were accompanied by an overall assessment of the evidence and a statement from the task force about the values, preferences, and task force insights that underlie the recommendations. Further details of the methodology that underpinned the evidence evaluation process are found in "Part 2: Evidence Evaluation and Management of Conflicts of Interest."The task force preselected and ranked outcome measures that were used as consistently as possible for all PICO questions. Longer-term, patient-centered outcomes were considered more important than process variables and shorter-term outcomes. For most questions, we used the following hierarchy starting with the most important: long-term survival with neurologically favorable survival, long-term survival, short-term survival, and process variable. In general, longterm was defined as from hospital discharge to 180 days or longer, and short-term was defined as shorter than to hospital discharge. For certain questions (eg, related to defibrillation or confirmation of tracheal tube position), process variables such as termination of fibrillation and correct tube placement were important. A few questions (eg, organ donation) required unique outcomes....

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“…White matter injury has also been observed in patients who suffer from transient cardiac arrest, and the prognosis has been reported to be worse in patients with severe white matter injury (Wu et al, 2009). Understanding the mechanism of white matter injury using an animal model is necessary for development of new treatments.…”

Section: Introductionmentioning

confidence: 99%

Consistent Injury to Medium Spiny Neurons and White Matter in the Mouse Striatum after Prolonged Transient Global Cerebral Ischemia

Yoshioka

Niizuma

Katsu

et al. 2011

Journal of Neurotrauma

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A reproducible transient global cerebral ischemia (tGCI) mouse model has not been fully established. Although striatal neurons and white matter are recognized to be vulnerable to ischemia, their injury after tGCI in mice has not been elucidated. The purpose of this study was to evaluate injuries to striatal neurons and white matter after tGCI in C57BL/6 mice, and to develop a reproducible tGCI model. Male C57BL/6 mice were subjected to tGCI by bilateral common carotid artery occlusion (BCCAO). Mice whose cortical cerebral blood flow after BCCAO decreased to less than 13% of the pre-ischemic value were used. Histological analysis showed that at 3 days after 22 min of BCCAO, striatal neurons were injured more consistently than those in other brain regions. Quantitative analysis of cytochrome c release into the cytosol and DNA fragmentation in the striatum showed consistent injury to the striatum. Immunohistochemistry and Western blot analysis revealed that DARPP-32-positive medium spiny neurons, the majority of striatal neurons, were the most vulnerable among the striatal neuronal subpopulations. The striatum (especially medium spiny neurons) was susceptible to oxidative stress after tGCI, which is probably one of the mechanisms of vulnerability. SMI-32 immunostaining showed that white matter in the striatum was also consistently injured 3 days after 22 min of BCCAO. We thus suggest that this is a tGCI model using C57BL/6 mice that consistently produces neuronal and white matter injury in the striatum by a simple technique. This model can be highly applicable for elucidating molecular mechanisms in the brain after global ischemia.

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Comatose Patients with Cardiac Arrest: Predicting Clinical Outcome with Diffusion-weighted MR Imaging

Cited by 169 publications

References 31 publications

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Targeted temperature management and neuroprognostication after cardiac arrest: A survey in Belgium

Part 4: Advanced Life Support

Consistent Injury to Medium Spiny Neurons and White Matter in the Mouse Striatum after Prolonged Transient Global Cerebral Ischemia

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