Jarnum H, Knutsson L, Rundgren M, et al. Diffusion and perfusion MRI of the brain in comatose patients treated with mild hypothermia after cardiac arrest: a prospective observational study

Centre for Medical Imaging and Physiology, Lund University Hospital, Lund, Sweden.
Resuscitation (Impact Factor: 4.17). 02/2009; 80(4):425-30. DOI: 10.1016/j.resuscitation.2009.01.004
Source: PubMed


Outcome for resuscitated cardiac arrest (CA) patients is poor. The 1-year survival rate with favourable neurological outcome (CPC 1-2) after out-of-hospital CA is reported to be 4%. Among resuscitated patients treated within an ICU, approximately 50% regain consciousness, whereas the other 50% remain comatose before they die. Induced hypothermia significantly improves the neurological outcome and survival in patients with primary CA who remain comatose after return of spontaneous circulation.
To evaluate magnetic resonance imaging (MRI) changes in resuscitated CA patients remaining in coma after treatment with hypothermia.
This prospective, observational study comprised 20 resuscitated CA patients who remained in coma 3 days after being treated with mild hypothermia (32-34 degrees C during 24h). Diffusion and perfusion MRI of the entire brain was performed approximately 5 days after CA. Autopsy was done on two patients.
The largest number of diffusion changes on MRI was found in the 16 patients who died. The parietal lobe showed the largest difference in number of acute ischaemic MRI lesions in deceased compared with surviving patients. Perfusion changes, > or = +/-2 SD compared with healthy volunteers from a previously published cerebral perfusion study, were found in seven out of eight patients. The autopsies showed lesions corresponding to the pathologic changes seen on MRI.
Diffusion and perfusion MRI are potentially helpful tools for the evaluation of ischaemic brain damage in resuscitated comatose patients treated with hypothermia after CA.

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Available from: Elisabet Englund, Jan 17, 2015
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    • "In the lack of confounding circumstances, such as sedatives, hypotension, hypothermia, or hypoxemia, it is reasonable to use unprocessed electroencephalography interpretation observed between 24 and 72 h after sustained ROSC to assist the prediction of a poor outcome in comatose survivors of cardiac arrest not treated with hypothermia [99] [100]. Some studies suggested the use of neuroimaging for predicting outcome in adult cardiac arrest survivors, but evidence is also lacking, and the current guidelines do not recommend for or against the routine use of neuroimaging with this purpose [101]. Patients resuscitated from cardiac arrest have a high rate of early mortality. "
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    • "To our knowledge, there are no papers describing repetitive MRI in the initial treatment of OHCA patients. Järnum and colleagues performed MRI on 20 cardiac arrest patients who remained unconscious 72 hours after normothermia [23]. They found hypoxic-ischemic cerebral oedema in two patients during neuropathological examination post mortem. "
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