Prognostic value of brainstem auditory and visual evoked potentials in cardiac arrest patients with targeted temperature management

Lim, Jee Yong; Oh, Sang Hoon; Park, Kyu Nam; Choi, Seung Pill; Oh, Joo Suk; Youn, Chun Song; Kim, Han Joon; Kim, Hyojoon; Song, Hyun

doi:10.1016/j.resuscitation.2021.04.024

Cited by 2 publications

(2 citation statements)

References 32 publications

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“…Absence of brainstem auditory evoked response (BAER) or brainstem reflexes such as the caloric reflex could indicate severe brainstem dysfunction and brain death 17, 18 . But current evidence suggests that it is unclear whether the use of auditory evoked potentials is suitable to predict poor neurological outcome after CPA in humans, 19 and the use of caloric reflexes have rarely been reported in the post‐CPA population 20 . Future studies on post‐CPA BAER and caloric reflex in dogs and cats would fill an important knowledge gap.…”

Section: Discussionmentioning

confidence: 99%

Brain magnetic resonance imaging and histopathology findings in a dog with global brain ischaemia following cardiopulmonary arrest

Goh

Eramanis²,

Milne

et al. 2022

Aust Veterinary J

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Background Global brain ischaemia following cardiopulmonary arrest is uncommonly reported in veterinary medicine yet neurologic injury after arrest is a known morbidity. Case report An 18‐week‐old male entire Cavalier King Charles Spaniel‐Poodle was referred following 3 days of neurologic abnormalities after cardiopulmonary arrest. After resuscitation, the animal had decerebrate rigidity, a stuporous mentation and intermittent episodes of vocalisation and apnoea. A brain magnetic resonance imaging (MRI) was undertaken 4 days after cardiopulmonary arrest, with standard sequences (T1‐weighted, T2‐weighted and fluid‐attenuated inversion recovery) as well as diffusion‐weighted imaging to better discern ischaemic injury and cytotoxic oedema for prognostic reasons. MRI findings were consistent with global brain ischaemia affecting the hippocampus, cerebellum and substantia nigra, the latter two not previously identified in canine cases of global brain ischaemia. The patient was euthanased on day eight post‐cardiopulmonary arrest due to a lack of neurological improvement and developing sepsis as a complication. Ante‐mortem identification of affected areas of the brain was confirmed on histological examination, with evidence of ischaemic injury seen in the cerebrum, hippocampus, cerebellum, basal nuclei and thalamus. Conclusion This report describes ante‐mortem MRI and postmortem findings in a dog with global brain ischaemia following cardiopulmonary arrest. A multimodal approach to neuroprognostication in patients recovering from cardiopulmonary arrest is recommended.

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Section: Discussionmentioning

confidence: 99%

Brain magnetic resonance imaging and histopathology findings in a dog with global brain ischaemia following cardiopulmonary arrest

Goh

Eramanis²,

Milne

et al. 2022

Aust Veterinary J

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“…After brain CT scanning, TTM at 33 • C or 36 • C for 24 h was started immediately. All comatose survivors after OHCA were treated in accordance with the local and international post-resuscitation care guidelines [20,21].…”

Section: Brain Ct Acquisitions and Post-resuscitation Carementioning

confidence: 99%

Can Optic Nerve Sheath Images on a Thin-Slice Brain Computed Tomography Reconstruction Predict the Neurological Outcomes in Cardiac Arrest Survivors?

Kwon

Jang

et al. 2022

JCM

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We analyzed the prognostic performance of optic nerve sheath diameter (ONSD) on thin-slice (0.6 mm) brain computed tomography (CT) reconstruction images as compared to routine-slice (4 mm) images. We conducted a retrospective analysis of brain CT images taken within 2 h after cardiac arrest. The maximal ONSD (mONSD) and optic nerve sheath area (ONSA) were measured on thin-slice images, and the routine ONSD (rONSD) and gray-to-white matter ratio (GWR) were measured on routine-slice images. We analyzed their area under the receiver operator characteristic curve (AUC) and the cutoff values for predicting a poor 6-month neurological outcome (a cerebral performance category score of 3–5). Of the 159 patients analyzed, 113 patients had a poor outcome. There was no significant difference in rONSD between the outcome groups (p = 0.116). Compared to rONSD, mONSD (AUC 0.62, 95% CI: 0.54–0.70) and the ONSA (AUC 0.63, 95% CI: 0.55–0.70) showed better prognostic performance and had higher sensitivities to determine a poor outcome (mONSD, 20.4% [95% CI, 13.4–29.0]; ONSA, 16.8% [95% CI, 10.4–25.0]; rONSD, 7.1% [95% CI, 3.1–13.5]), with specificity of 95.7% (95% CI, 85.2–99.5). A combined cutoff value obtained by both the mONSD and GWR improved the sensitivity (31.0% [95% CI, 22.6–40.4]) of determining a poor outcome, while maintaining a high specificity. In conclusion, rONSD was clinically irrelevant, but the mONSD had an increased sensitivity in cutoff having acceptable specificity. Combination of the mONSD and GWR had an improved prognostic performance in these patients.

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Prognostic value of brainstem auditory and visual evoked potentials in cardiac arrest patients with targeted temperature management

Cited by 2 publications

References 32 publications

Brain magnetic resonance imaging and histopathology findings in a dog with global brain ischaemia following cardiopulmonary arrest

Brain magnetic resonance imaging and histopathology findings in a dog with global brain ischaemia following cardiopulmonary arrest

Can Optic Nerve Sheath Images on a Thin-Slice Brain Computed Tomography Reconstruction Predict the Neurological Outcomes in Cardiac Arrest Survivors?

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