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Introducing advanced neuroimaging into pediatric post-arrest neuroprognostication

Published:December 05, 2022DOI:https://doi.org/10.1016/j.resuscitation.2022.11.023
Introducing advanced neuroimaging into pediatric post-arrest neuroprognostication
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      In children, the severity of hypoxic-ischemic brain injury (HIBI) after cardiac arrest is the primary determinant of short- and longer-term morbidity and mortality.
      • Topjian A.A.
      • de Caen A.
      • Wainwright M.S.
      • et al.
      Pediatric post-cardiac arrest care: A scientific statement from the American Heart Association.
      Circulation. 2019; CIR0000000000000697
      , 
      • Topjian A.A.
      • Raymond T.T.
      • Atkins D.
      • et al.
      Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
      Circulation. 2020; 142: S469-S523
      Prognosticating outcome is challenging and requires a multimodal approach that includes integrating clinical data with information from the neurologic examination, electroencephalography (EEG), and neuroimaging.
      • Hunfeld M.
      • Muusers M.A.C.
      • Catsman C.E.
      • Castillo J.D.
      • Tibboel D.
      • Buysse C.M.P.
      The current practice regarding neuro-prognostication for comatose children after cardiac arrest differs between and within European PICUs: A survey.
      Eur J Paediatr Neurol. 2020; 28: 44-51
      Conventional neuroimaging like computerized tomography (CT) and magnetic resonance imaging (MRI) can quantify the overall extent of structural brain injury. Neurologic outcomes have been associated with burden of HIBI to the whole brain and specific structures.
      • Kirschen M.P.
      • Licht D.J.
      • Faerber J.
      • et al.
      Association of MRI brain injury with outcome after pediatric out-of-hospital cardiac arrest.
      Neurology. 2020;
      , 
      • Manchester L.C.
      • Lee V.
      • Schmithorst V.
      • Kochanek P.M.
      • Panigrahy A.
      • Fink E.L.
      Global and regional derangements of cerebral blood flow and diffusion magnetic resonance imaging after pediatric cardiac arrest.
      J Pediatr. 2016; 169: 28-35.e1
      , 
      • Yacoub M.
      • Birchansky B.
      • Mlynash M.
      • et al.
      The prognostic value of quantitative diffusion-weighted MRI after pediatric cardiopulmonary arrest.
      Resuscitation. 2019; 135: 103-109
      , 
      • Sandroni C.
      • D'Arrigo S.
      • Cacciola S.
      • et al.
      Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
      Intensive Care Med. 2020; 46: 1803-1851
      Advanced neuroimaging modalities like diffusion tensor imaging (DTI) and functional MRI have potential to provide more detailed information about microstructural white matter injury and impairments in functional connectivity between brain regions, which in turn may aid in understanding the pathophysiology of post-arrest HIBI and improve prognostic accuracy.
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      References

        • Topjian A.A.
        • de Caen A.
        • Wainwright M.S.
        • et al.
        Pediatric post-cardiac arrest care: A scientific statement from the American Heart Association.
        Circulation. 2019; CIR0000000000000697
        View in Article
        • Topjian A.A.
        • Raymond T.T.
        • Atkins D.
        • et al.
        Part 4: Pediatric basic and advanced life support: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care.
        Circulation. 2020; 142: S469-S523
        View in Article
        • Hunfeld M.
        • Muusers M.A.C.
        • Catsman C.E.
        • Castillo J.D.
        • Tibboel D.
        • Buysse C.M.P.
        The current practice regarding neuro-prognostication for comatose children after cardiac arrest differs between and within European PICUs: A survey.
        Eur J Paediatr Neurol. 2020; 28: 44-51
        View in Article
        • Kirschen M.P.
        • Licht D.J.
        • Faerber J.
        • et al.
        Association of MRI brain injury with outcome after pediatric out-of-hospital cardiac arrest.
        Neurology. 2020;
        View in Article
        • Manchester L.C.
        • Lee V.
        • Schmithorst V.
        • Kochanek P.M.
        • Panigrahy A.
        • Fink E.L.
        Global and regional derangements of cerebral blood flow and diffusion magnetic resonance imaging after pediatric cardiac arrest.
        J Pediatr. 2016; 169: 28-35.e1
        View in Article
        • Yacoub M.
        • Birchansky B.
        • Mlynash M.
        • et al.
        The prognostic value of quantitative diffusion-weighted MRI after pediatric cardiopulmonary arrest.
        Resuscitation. 2019; 135: 103-109
        View in Article
        • Sandroni C.
        • D'Arrigo S.
        • Cacciola S.
        • et al.
        Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review.
        Intensive Care Med. 2020; 46: 1803-1851
        View in Article
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        • Lighthall N.R.
        Application of graph theory for identifying connectivity patterns in human brain networks: A systematic review.
        Front Neurosci. 2019; 13: 585
        View in Article

      9. Jarvis JM, Roy J, Schmithorst V, et al. Limbic pathway vulnerability associates with neurologic outcome in children after cardiac arrest. Resuscitation 2023;182:1–9.

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        Use of brain diffusion tensor imaging for the prediction of long-term neurological outcomes in patients after cardiac arrest: a multicentre, international, prospective, observational, cohort study.
        Lancet Neurol. 2018; 17: 317-326
        View in Article
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        Relationship between diffusion tensor imaging (DTI) findings and cognition following pediatric TBI: A meta-analytic review.
        Dev Neuropsychol. 2016; 41: 176-200
        View in Article
        • Yu Q.
        • Peng Y.
        • Kang H.
        • et al.
        Differential white matter maturation from birth to 8 years of age.
        Cereb Cortex. 2020; 30: 2673-2689
        View in Article
        • Snider S.B.
        • Edlow B.L.
        MRI in disorders of consciousness.
        Curr Opin Neurol. 2020; 33: 676-683
        View in Article

      Article info

      Publication history

      Published online: December 05, 2022
      Accepted: November 25, 2022
      Received: November 22, 2022

      Identification

      DOI: https://doi.org/10.1016/j.resuscitation.2022.11.023

      Copyright

      © 2022 Elsevier B.V. All rights reserved.

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