Brain MR imaging and spectroscopy for outcome prognostication after pediatric cardiac arrest.
Cardiac arrest
Magnetic resonance imaging
Magnetic resonance spectroscopy
Outcome
Pediatric
Prognostication
Journal
Resuscitation
ISSN: 1873-1570
Titre abrégé: Resuscitation
Pays: Ireland
ID NLM: 0332173
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
26
03
2020
revised:
09
06
2020
accepted:
16
06
2020
pubmed:
13
7
2020
medline:
22
6
2021
entrez:
13
7
2020
Statut:
ppublish
Résumé
Children surviving cardiac arrest are at high risk of neurological morbidity and mortality; however, there is a lack of validated prognostic biomarkers. We aimed to evaluate brain magnetic resonance imaging (MRI) and spectroscopy (MRS) as predictors of death and disability. Secondly, we evaluated whether MRI/S by randomized group. This single center study analyzed clinically indicated brain MRI/S data from children enrolled in a randomized controlled trial of 24 vs. 72 h of hypothermia following cardiac arrest. Two pediatric radiologists scored conventional MRIs. Lactate and N-acetyl-aspartate (NAA) concentrations (mmol/kg) were determined from spectra acquired from the basal ganglia, thalamus, parietal white matter and parietooccipital gray matter. Mortality and neurological outcomes (favorable = Pediatric Cerebral Performance Category [PCPC] 1, 2, 3 or increase < 2) were assessed at hospital discharge. Non-parametric tests were used to test for associations between MRI/S biomarkers and outcome and randomized group. 23 children with (median [interquartile range]) age of 1.5 (0.3-4.0) years. Ten (44%) had favorable outcome. There were more T2 brain lesions in the lentiform nuclei in children with unfavorable 12 (92%) vs. favorable 3 (33%) outcome, p = 0.007. Increased lactate and decreased NAA concentrations in the parietooccipital gray matter and decreased NAA in the parietal white matter were associated with unfavorable outcome (p's < 0.05). There were no differences for any biomarker by randomized group. Regional cerebral and metabolic MRI/S biomarkers are predictive of neurological outcomes at hospital discharge in pediatric cardiac arrest and should undergo validation testing in a large sample.
Identifiants
pubmed: 32653571
pii: S0300-9572(20)30271-9
doi: 10.1016/j.resuscitation.2020.06.033
pmc: PMC7769908
mid: NIHMS1610932
pii:
doi:
Banques de données
ClinicalTrials.gov
['NCT00797680']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
185-194Subventions
Organisme : NICHD NIH HHS
ID : K23 HD099309
Pays : United States
Organisme : NCRR NIH HHS
ID : UL1 RR024153
Pays : United States
Organisme : NINDS NIH HHS
ID : K23 NS065132
Pays : United States
Organisme : NINDS NIH HHS
ID : R01 NS096714
Pays : United States
Organisme : NICHD NIH HHS
ID : K12 HD047349
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020 Elsevier B.V. All rights reserved.
Références
Pediatr Radiol. 2017 May;47(5):534-543
pubmed: 28409254
Circulation. 2019 Aug 6;140(6):e194-e233
pubmed: 31242751
Crit Care Med. 2011 Jan;39(1):141-9
pubmed: 20935561
Resuscitation. 2010 Nov;81(11):1577-83
pubmed: 20727661
Circ Cardiovasc Qual Outcomes. 2013 Jan 1;6(1):42-9
pubmed: 23250980
J Neurol. 2004 Apr;251(4):388-97
pubmed: 15083282
Ann Neurol. 1997 Apr;41(4):470-81
pubmed: 9124804
J Clin Pathol Suppl (R Coll Pathol). 1977;11:170-80
pubmed: 269118
Circulation. 2009 Mar 24;119(11):1484-91
pubmed: 19273724
AJNR Am J Neuroradiol. 1999 Sep;20(8):1399-405
pubmed: 10512219
Pediatrics. 2016 Apr;137(4):
pubmed: 26940987
Pediatr Crit Care Med. 2008 Jan;9(1):32-9
pubmed: 18477911
Arch Dis Child Fetal Neonatal Ed. 2019 Sep;104(5):F515-F520
pubmed: 30425113
Pediatr Radiol. 2017 May;47(5):544-555
pubmed: 28409252
Resuscitation. 2018 May;126:14-20
pubmed: 29454009
Arch Dis Child Fetal Neonatal Ed. 2012 Nov;97(6):F398-404
pubmed: 23080477
J Child Neurol. 2016 Dec;31(14):1584-1590
pubmed: 27591003
J Pediatr. 1992 Jul;121(1):68-74
pubmed: 1625096
Arch Pediatr Adolesc Med. 1995 Feb;149(2):210-4
pubmed: 7849887
Lancet Neurol. 2010 Jan;9(1):39-45
pubmed: 19896902
Neurocrit Care. 2011 Feb;14(1):61-7
pubmed: 20931362
Pediatr Crit Care Med. 2004 Mar;5(2):139-44
pubmed: 14987343
Pediatr Radiol. 2010 Jan;40(1):3-30
pubmed: 19937238
Circulation. 2019 Aug 27;140(9):e517-e542
pubmed: 31291775
Magn Reson Med. 1993 Dec;30(6):672-9
pubmed: 8139448
Int Emerg Nurs. 2010 Jan;18(1):8-28
pubmed: 20129438
Crit Care Med. 2020 Feb;48(2):e107-e114
pubmed: 31939809
AJNR Am J Neuroradiol. 2002 Apr;23(4):716-23
pubmed: 11950675
Intensive Care Med. 2013 Jul;39(7):1306-12
pubmed: 23632740
Semin Perinatol. 2015 Mar;39(2):73-104
pubmed: 25743582
Pediatr Crit Care Med. 2016 Jun;17(6):498-507
pubmed: 27124565
Neurocrit Care. 2013 Aug;19(1):31-40
pubmed: 22535278