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Acute brain lesions on MRI in relation to neurological outcome 6 months after cardiac arrest treated with hypothermia.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
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2015 (English)In: Resuscitation, ISSN 0300-9572, E-ISSN 1873-1570, Vol. 96, no Suppl1, 147- p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Aim of the study: To document the acute magnetic resonance imaging (MRI) findings on the brain in cardiac arrest (CA) patients treated with therapeutic hypothermia (TH) and their relation to patients’ neurological outcome after 6 months.

Method: A prospective observational study with MRI was performed regardless the level of consciousness in 56 post-CA patients treated with TH.

Results: MRI of the brain was obtained at a median of 4 days  (3-13 days). At 6 months, 32/56 had survived with good neurological outcome. The MMSE was performed in 28/32 (88%) patients with a median of 28 (24-30). Acute ischemic lesions were found on diffusion-weighted MRI (DWI) in 34 (61%) patients and were more common in patients with poor outcome (p=0.006). Acute ischemic injuries affected mostly gray matter, deep or cortical and with or without involvement of the underlying white matter. Very few lesions were pure white matter lesions. Lesions in the occipital and temporal lobes, deep gray matter and cerebellum were most associated with poor outcome. Reductions in the apparent diffusion coefficient (ADC) were more common in patients with poor outcome, particularly in the occipital lobes. None of the patients with an ADC below 600x10-6 mm2/s in any region survived to 6 months.

Conclusions: In visual analyses of acute MRI, extensive acute lesions were found in the cortical regions and gray matter and were associated with poor outcome. In ADC measurements, low values were associated with poor outcome. Patients with good outcome showed a minor pathological pattern mainly in the frontal and parietal lobes.

 

Place, publisher, year, edition, pages
2015. Vol. 96, no Suppl1, 147- p.
Keyword [en]
cardiac arrest, hypothermia, MRI, diffusion brain acute lesions, neurological outcome
National Category
Anesthesiology and Intensive Care Neurology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Medical Science; Anaesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:uu:diva-248025OAI: oai:DiVA.org:uu-248025DiVA: diva2:805326
Conference
Congress of European Resuscitation Council 2015, Prag, Czech Republic
Available from: 2015-04-15 Created: 2015-03-26 Last updated: 2017-10-25
In thesis
1. Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
Open this publication in new window or tab >>Post Cardiac Arrest Care: Evaluation of prognostic tools, Patient outcomes and Relatives’ experiences at 6 months after the event
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of the present thesis was to study post-resuscitation care of cardiac arrest (CA) patients treated with target temperature management 33°C with a focus on evaluation of two prognostic tools: variations in cerebral venous saturation and acute magnetic resonance imaging (MRI) findings on the brain post-CA. An additional aim was to investigate patients’ neurological outcome and relatives’ experiences 6 months after the event. Paper I describes the cerebral oxygen saturation of blood obtained from a jugular bulb (SjvO2) catheter The results showed that patients with poor outcome tended to have higher SjvO2values,but this difference was only significant at 96 and108 hours post-CA. The main findings of Paper II were that patients with good outcome displayed a pathological pattern mainly in the frontal and parietal lobes on MRI of the brain. Patients with poor outcome had an extensive pathological pattern in several brain regions. Furthermore, very low apparent diffusion coefficient (ADC) values were associated with poor outcome regardless of brain region. Paper III investigated physical and cognitive function over time, between one month and 6 months post-CA, as well as d life satisfaction at 6 months. The results showed that impairment in physical and cognitive function is common in CA survivors but tends to decrease over time. Despite a severe illness, which has impaired the physical and cognitive functions, satisfaction with life as a whole was reported by 70% of CA survivors. In Paper IV, relatives described their experiences 6 months after a significant others CA. The analysis resulted in three themes reflecting relatives’ everyday life 6 months after the event: Difficulties managing a changed life situation, Feeling like I come second and Feeling new hope for the future. In conclusion, the results of the present thesis have increased our understanding of the two prognostic tools that were investigated; they have generated new and revealed aspects that should be taken into account during prognostication and assessing neurological outcome of this group of patients. The thesis has also shown that the healthcare needs to improve its routines for follow-ups and information provision to both patients and their relatives.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 90 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1094
Keyword
cardiac arrest, hypothermia, neurological outcome, cerebral oxygenation, MRI, relatives
National Category
Anesthesiology and Intensive Care
Research subject
Medical Science
Identifiers
urn:nbn:se:uu:diva-248044 (URN)978-91-554-9225-0 (ISBN)
Public defence
2015-05-22, Grönvallsalen, ing 70, bv., Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2015-04-28 Created: 2015-03-26 Last updated: 2015-07-07

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Wallin, EwaLarsson, Ing-MarieRubertsson, StenLarsson, Elna-MarieRaininko, Raili

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