Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial

Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. The primary aim was to compare the pat...

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Published in:	Australian critical care p. 101130
Main Authors:	Eastwood, Glenn M., Bailey, Michael, Nichol, Alistair D., Dankiewicz, Josef, Nielsen, Niklas, Parke, Rachael, Cronberg, Tobias, Olasveengen, Theresa, Grejs, Anders M., Iten, Manuela, Haenggi, Matthias, McGuigan, Peter, Wagner, Franca, Moseby-Knappe, Marion, Lang, Margareta, Bellomo, Rinaldo, Hodgson, Carol, McGuinness, Shay, Bernard, Stephen, Skrifvars, Markus B., Stub, Dion, Taccone, Fabio S., Archer, John, Kutsogiannis, Demetrios, Lilja, Gisela, Kirkegaard, Hans, Capellier, Gilles, Landoni, Giovanni, Horn, Janneke, Arabi, Yaseen, Chia, Yew Woon, Markota, Andrej, Wise, Matt P., Christensen, Steffen, Munk-Andersen, Heidi, Granfeldt, Asger, Andersen, Geir Ø., Qvigstad, Eirik, Flaa, Arnljot, Thomas, Matthew, Sweet, Katie, Bewley, Jeremy, Bäcklund, Minna, Tiainen, Marjaana, Levis, Anja, Peck, Leah, Walsham, James, Deane, Adam, Ghosh, Angajendra, Annoni, Filippo, Chen, Yan, Knight, David, Lesona, Eden, Tlayjeh, Haytham, Svenšek, Franc, Cole, Jade, Pogson, David, Hilty, Matthias P., Düring, Joachim P., Paul, Eldho, Ady, Bridget, Ainscough, Kate, Hunt, Anna, Monahan, Sinéad, Trapani, Tony, Fahey, Ciara
Format:	Journal Article
Language:	English
Published:	Elsevier Ltd 07-11-2024
Subjects:	Magnetic resonance imaging Mortality Neuroprognostication Out-of-hospital cardiac arrest Post–cardiac arrest care Out-of-hospital cardiac arrest Post–cardiac arrest care Magnetic resonance imaging Neuroprognostication Mortality
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Summary:	Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed. In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1036-7314
DOI:	10.1016/j.aucc.2024.09.015