Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication After Cardiac Arrest

Endisch, Christian; Westhall, Erik; Kenda, Martin; Streitberger, Kaspar Josche; Kirkegaard, Hans; Stenzel, Werner; Ploner, Christoph J.; Cronberg, Tobias; Friberg, Hans; Englund, Elisabet; Leithner, Christoph

doi:10.1001/jamaneurol.2020.2340

Cited by 62 publications

(65 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…12 Recently, Endisch et al investigated the relation between SSEP amplitudes and histopathologically determined severity of postanoxic encephalopathy. 13 They found that no patient with no or mild postanoxic encephalopathy had SSEP amplitudes < 0.5 mV. This shows that very low SSEP amplitudes also strongly predict severe brain damage and therefore supports our results.…”

Section: Discussionsupporting

confidence: 88%

SSEP amplitudes add information for prognostication in postanoxic coma

et al. 2021

View full text Add to dashboard Cite

Objective: To investigate whether somatosensory evoked potential (SSEP) amplitude adds information for prediction of poor outcome in postanoxic coma. Methods:In this retrospective cohort study we included adult patients admitted after cardiac arrest between January 2010 and June 2018 who remained in coma and had SSEP recorded for prognostication. Outcome was dichotomized in poor (Cerebral Performance Category (CPC) 4À5) and good (CPC 1À3) at ICU discharge. Sensitivity of bilaterally absent N20 potential was calculated. In case the N20 potential was not bilaterally absent, the amplitude contralateral to stimulation side (baseline-N20, N20-P25, and maximum) was determined. At a specificity of 100%, SEPP amplitude sensitivities were determined for poor outcome.Results: SSEP recordings were performed in 197 patients of whom 57 had bilaterally absent N20 potentials. From 140 patients, 16 (11%) had a good outcome. The sensitivity for poor outcome of bilaterally absent N20 was 31%. At a specificity of 100%, contralateral amplitude thresholds were 0.34 mV (baseline-N20), 0.99 mV (N20-P25) and 1.0 mV (maximum), corresponding to a sensitivity for poor outcome of 38%, 44% and 40%. Combination of bilaterally absent N20 and a N20-P25 threshold below 0.99 mV yielded a sensitivity of 62%.Conclusions: Our results confirm that very low cortical SSEP amplitudes are highly predictive of poor outcome in patients with postanoxic coma. Adding 'N20-P25 threshold amplitude' to the 'bilaterally absent N20 0 criterion, increased sensitivity substantially.

show abstract

Section: Discussionsupporting

confidence: 88%

SSEP amplitudes add information for prognostication in postanoxic coma

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Though prior literature contends that the hippocampus may be particularly vulnerable to anoxia 3 , we did not identify preferential ABI in the hippocampus. However, it possible that these clinical diffusion weighted scans, which poorly discriminate mesial temporal structures 48 , had insufficient resolution to fully assess hippocampal ABI.…”

Section: Discussionmentioning

confidence: 64%

“…Neuropathologic studies in animals 1 and humans 2,3 have identified numerous brain regions susceptible to anoxic injury, but a map of brain regions affected by cardiac arrest does not yet exist. Furthermore, although disorders of consciousness (DoC) 4,5 , EEG background suppression 6,7 and seizures [7][8][9][10] predict poor neurological outcomes after cardiac arrest 3,11,12 , the regional patterns of anoxic brain injury (ABI) associated with each are unknown 3,13 . Diffusion MRI is the most sensitive imaging modality for the clinical characterization of anoxic brain injury (ABI) [14][15][16][17][18][19] .…”

Section: Introductionmentioning

confidence: 99%

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

Fischer

et al. 2021

Preprint

View full text Add to dashboard Cite

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.

show abstract

“…These authors also noted that with restoration towards continuous EEG rhythms (within 24 hours of cardiac arrest), there were no signs of structural neuronal damage. A more extensive multicenter histopathological evaluation of 187 non-survivors found severe HIE in patients with absent SSEPs and suppressed or burst suppressed EEGs [74]. Furthermore, they observed that as the severity of HIE increased the amplitude of SSEPs decreased, and the EEG progressed from generalised periodic discharges to burst suppression to suppression patterns.…”

Section: Discussionmentioning

confidence: 99%

A Review of the Electrophysiological Neuroprognostications after Out of Hospital Cardiac Arrest

Skorko¹,

Pachucki²,

Taylor³

et al. 2021

ACR

View full text Add to dashboard Cite

This personal opinion review of the potential role for EEG in the multimodal neuroprognostication of comatose cardiac arrest patients, after resuscitation and targeted temperature management, discusses recent findings along with our personal experience from a large single-center cohort of 220 consecutive patients investigated with electrophysiological tests (EEG and SSEP). Although EEG has its limitations, along with all modalities in the multimodal prognostic framework, when timed appropriately and interpreted in a standardized fashion, it can be probabilistic but not deterministic of an individual patient’s neurological prognosis. The EEG phenotype can indicate both good and poor prognoses for a comatose patient on the Intensive Care Unit, which is a distinct advantage of this widely available modality, whilst an SSEP can reliably predict a poor outcome if absent and may also help predict good outcome using amplitude analysis.

show abstract

Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication After Cardiac Arrest

Cited by 62 publications

References 44 publications

SSEP amplitudes add information for prognostication in postanoxic coma

SSEP amplitudes add information for prognostication in postanoxic coma

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

A Review of the Electrophysiological Neuroprognostications after Out of Hospital Cardiac Arrest

Contact Info

Product

Resources

About