Early Functional Connectome Integrity and 1-Year Recovery in Comatose                    Survivors of Cardiac Arrest

Sair, Haris I.; Hannawi, Yousef; Li, Shanshan; Kornbluth, Joshua; Demertzi, Athina; Perri, Carol Di; Chabanne, Russell; Jean, Betty; Benali, Habib; Perlbarg, Vincent; Pekar, James J.; Luyt, Charles‐Édouard; Galanaud, Damien; Velly, Lionel; Puybasset, Louis; Laureys, Steven; Caffo, Brian; Stevens, Robert

doi:10.1148/radiol.2017162161

Cited by 54 publications

(47 citation statements)

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“…18 It has been recently shown that fMRI could detect early signs of consciousness in response to passive stimulation in comatose patients following traumatic brain injury 19 and that FC strength correlated with favorable long-term outcome in postanoxic patients in a coma. 20 However, rs-fMRI has yet to be systematically assessed for the early prognostication of the postanoxic patient in a coma.…”

mentioning

confidence: 99%

Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis

Pugin¹,

Hofmeister²,

Gasche³

et al. 2020

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE: Early outcome prediction of postanoxic patients in a coma after cardiac arrest proves challenging. Current prognostication relies on multimodal testing, using clinical examination, electrophysiologic testing, biomarkers, and structural MR imaging. While this multimodal prognostication is accurate for predicting poor outcome (ie, death), it is not sensitive enough to identify good outcome (ie, consciousness recovery), thus leaving many patients with indeterminate prognosis. We specifically assessed whether resting-state fMRI provides prognostic information, notably in postanoxic patients in a coma with indeterminate prognosis early after cardiac arrest, specifically for good outcome. MATERIALS AND METHODS: We used resting-state fMRI in a prospective study to compare whole-brain functional connectivity between patients with good and poor outcomes, implementing support vector machine learning. Then, we automatically predicted coma outcome using resting-state fMRI and also compared the prediction based on resting-state fMRI with the outcome prediction based on DWI. RESULTS: Of 17 eligible patients who completed the study procedure (among 351 patients screened), 9 regained consciousness and 8 remained comatose. We found higher functional connectivity in patients recovering consciousness, with greater changes occurring within and between the occipitoparietal and temporofrontal regions. Coma outcome prognostication based on resting-state fMRI machine learning was very accurate, notably for identifying patients with good outcome (accuracy, 94.4%; area under the receiver operating curve, 0.94). Outcome predictors using resting-state fMRI performed significantly better (P , .05) than DWI (accuracy, 60.0%; area under the receiver operating curve, 0.63). CONCLUSIONS: Indeterminate prognosis might lead to major clinical uncertainty and significant variations in life-sustaining treatments. Resting-state fMRI might bridge the gap left in early prognostication of postanoxic patients in a coma by identifying those with both good and poor outcomes. ABBREVIATIONS: CA ¼ cardiac arrest; EEG ¼ electroencephalography; FC ¼ functional connectivity; ICU ¼ intensive care unit; LOOCV ¼ leave-one-out cross-validation; NPV ¼ negative predictive value; PPV ¼ positive predictive value; rs-fMRI ¼ resting-state fMRI C ardiac arrest (CA) is an important cause of death in the United States and Europe, with an annual incidence of 110/ 100,000. 1,2 Only 7.6% of patients treated for out-of-hospital cardiac arrest survive to hospital discharge. In Europe, 128,000-275,000 individuals per year are treated for out-of-hospital cardiac arrest, and 10% survive. 2,3 Due to improvements made in prehospital and intrahospital CA management, a growing number of patients survive the first days following CA, yet can remain unconscious. The main factor determining death in patients with out-of-hospital cardiac arrest admitted to the intensive care unit (ICU), accounting for two-thirds of deaths, is postanoxic brain injury, which leads to a w...

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confidence: 99%

Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis

Pugin¹,

Hofmeister²,

Gasche³

et al. 2020

AJNR Am J Neuroradiol

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“…In a positron emission tomography (PET) pilot study of 7 post-CA patients, all initially demonstrated a low cerebral metabolic rate of oxygen metabolism (CMR02) and cerebral blood flow; however, at day 7, those with persistent coma had lower CMR02 compared to those who regained consciousness ( 93 ). More recently, fMRI connectome imaging has demonstrated potential as a prognostic tool in CA, where patients who achieved favorable outcome have higher default-mode network connectivity ( 94 , 95 ). It is unclear if fMRI is more accurate in predicting outcome in comparison to other MRI modalities ( 94 ), and they have not been compared directly with more established prognostic tools ( 92 ).…”

Section: Imaging Modalities After Cardiac Arrestmentioning

confidence: 99%

“…More recently, fMRI connectome imaging has demonstrated potential as a prognostic tool in CA, where patients who achieved favorable outcome have higher default-mode network connectivity ( 94 , 95 ). It is unclear if fMRI is more accurate in predicting outcome in comparison to other MRI modalities ( 94 ), and they have not been compared directly with more established prognostic tools ( 92 ). Validation of PET imaging and other fMRI techniques may be a field of future research.…”

Section: Imaging Modalities After Cardiac Arrestmentioning

confidence: 99%

Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

et al. 2018

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Out-of-hospital cardiac arrest (CA) remains a leading cause of sudden morbidity and mortality; however, outcomes have continued to improve in the era of targeted temperature management (TTM). In this review, we highlight the clinical use of TTM, and provide an updated summary of multimodality monitoring possible in a modern ICU. TTM is neuroprotective for survivors of CA by inhibiting multiple pathophysiologic processes caused by anoxic brain injury, with a final common pathway of neuronal death. Current guidelines recommend the use of TTM for out-of-hospital CA survivors who present with a shockable rhythm. Further studies are being completed to determine the optimal timing, depth and duration of hypothermia to optimize patient outcomes. Although a multidisciplinary approach is necessary in the CA population, neurologists and neurointensivists are central in selecting TTM candidates and guiding patient care and prognostic evaluation. Established prognostic tools include clinal exam, SSEP, EEG and MR imaging, while functional MRI and invasive monitoring is not validated to improve outcomes in CA or aid in prognosis. We recommend that an evidence-based TTM and prognostication algorithm be locally implemented, based on each institution's resources and limitations. Given the high incidence of CA and difficulty in predicting outcomes, further study is urgently needed to determine the utility of more recent multimodality devices and studies.

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“…Resting state functional MRI (rs-fMRI) has shown that the architecture of topographically distinct large-scale networks is massively disrupted after severe brain injury [7]. Additionally, recent work has found that connectivity strength within and between resting-state networks is predictive of long-term functional outcome following severe neurological insults such as anoxic brain injury [8]. These findings support MRI-derived structural and functional connectivity indices as versatile biomarkers in unresponsive patients.…”

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confidence: 75%

Precision Medicine for Traumatic Coma

Hannawi

Stevens

2020

Neurocrit Care

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Early Functional Connectome Integrity and 1-Year Recovery in Comatose Survivors of Cardiac Arrest

Cited by 54 publications

References 46 publications

Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis

Resting-State Brain Activity for Early Prediction Outcome in Postanoxic Patients in a Coma with Indeterminate Clinical Prognosis

Targeted Temperature Management and Multimodality Monitoring of Comatose Patients After Cardiac Arrest

Precision Medicine for Traumatic Coma

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