• Hanneke M Keijzer, Marlous M L H Verhulst, Frederick J A Meijer, Bart A R Tonino, Frank H Bosch, KlijnCatharina J MCJMDepartment of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands., HoedemaekersCornelia W ECWEDepartment of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands., and Jeannette Hofmeijer.
• Department of Neurology, Rijnstate Hospital, P.O. box 9555, 6800 TA, Arnhem, The Netherlands. HMKeijzer@rijnstate.nl.
• Neurocrit Care. 2022 Aug 1; 37 (1): 302-313.

BackgroundDespite application of the multimodal European Resuscitation Council and European Society of Intensive Care Medicine algorithm, neurological prognosis of patients who remain comatose after cardiac arrest remains uncertain in a large group of patients. In this study, we investigate the additional predictive value of visual and quantitative brain magnetic resonance imaging (MRI) to electroencephalography (EEG) for outcome estimation of comatose patients after cardiac arrest.MethodsWe performed a prospective multicenter cohort study in patients after cardiac arrest submitted in a comatose state to the intensive care unit of two Dutch hospitals. Continuous EEG was recorded during the first 3 days and MRI was performed at 3 ± 1 days after cardiac arrest. EEG at 24 h and ischemic damage in 21 predefined brain regions on diffusion weighted imaging and fluid-attenuated inversion recovery on a scale from 0 to 4 were related to outcome. Quantitative MRI analyses included mean apparent diffusion coefficient (ADC) and percentage of brain volume with ADC < 450 × 10-6 mm2/s, < 550 × 10-6 mm2/s, and < 650 × 10-6 mm2/s. Poor outcome was defined as a Cerebral Performance Category score of 3-5 at 6 months.ResultsWe included 50 patients, of whom 20 (40%) demonstrated poor outcome. Visual EEG assessment correctly identified 3 (15%) with poor outcome and 15 (50%) with good outcome. Visual grading of MRI identified 13 (65%) with poor outcome and 25 (89%) with good outcome. ADC analysis identified 11 (55%) with poor outcome and 3 (11%) with good outcome. EEG and MRI combined could predict poor outcome in 16 (80%) patients at 100% specificity, and good outcome in 24 (80%) at 63% specificity. Ischemic damage was most prominent in the cortical gray matter (75% vs. 7%) and deep gray nuclei (45% vs. 3%) in patients with poor versus good outcome.ConclusionsMagnetic resonance imaging is complementary with EEG for the prediction of poor and good outcome of patients after cardiac arrest who are comatose at admission.© 2022. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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