• Carita Hollmén, Riitta Parkkola, Victor Vorobyev, Jani Saunavaara, Ruut Laitio, Olli Arola, Marja Hynninen, Minna Bäcklund, Juha Martola, Emmi Ylikoski, Risto O Roine, Marjaana Tiainen, Harry Scheinin, Mervyn Maze, Tero Vahlberg, and Timo T Laitio.
• Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland.
• Neurocrit Care. 2024 Jul 9.

BackgroundWe have earlier reported that inhaled xenon combined with hypothermia attenuates brain white matter injury in comatose survivors of out-of-hospital cardiac arrest (OHCA). A predefined secondary objective was to assess the effect of inhaled xenon on the structural changes in gray matter in comatose survivors after OHCA.MethodsPatients were randomly assigned to receive either inhaled xenon combined with target temperature management (33 °C) for 24 h (n = 55, xenon group) or target temperature management alone (n = 55, control group). A change of brain gray matter volume was assessed with a voxel-based morphometry evaluation of high-resolution structural brain magnetic resonance imaging (MRI) data with Statistical Parametric Mapping. Patients were scheduled to undergo the first MRI between 36 and 52 h and a second MRI 10 days after OHCA.ResultsOf the 110 randomly assigned patients in the Xe-Hypotheca trial, 66 patients completed both MRI scans. After all imaging-based exclusions, 21 patients in the control group and 24 patients in the xenon group had both scan 1 and scan 2 available for analyses with scans that fulfilled the quality criteria. Compared with the xenon group, the control group had a significant decrease in brain gray matter volume in several clusters in the second scan compared with the first. In a between-group analysis, significant reductions were found in the right amygdala/entorhinal cortex (p = 0.025), left amygdala (p = 0.043), left middle temporal gyrus (p = 0.042), left inferior temporal gyrus (p = 0.008), left parahippocampal gyrus (p = 0.042), left temporal pole (p = 0.042), and left cerebellar cortex (p = 0.005). In the remaining gray matter areas, there were no significant changes between the groups.ConclusionsIn comatose survivors of OHCA, inhaled xenon combined with targeted temperature management preserved gray matter better than hypothermia alone.Clinical Trial RegistrationClinicalTrials.gov: NCT00879892.© 2024. Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society.

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