Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial

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dc.contributor.authorEastwood, G.M.
dc.contributor.authorBailey, M.
dc.contributor.authorNichol, A.D.
dc.contributor.authorDankiewicz, J.
dc.contributor.authorNielsen, N.
dc.contributor.authorParke, R.
dc.contributor.authorCronberg, T.
dc.contributor.authorOlasveengen, T.
dc.contributor.authorGrejs, A.M.
dc.contributor.authorIten, M.
dc.contributor.authorHaenggi, M.
dc.contributor.authorMcGuigan, P.
dc.contributor.authorWagner, F.
dc.contributor.authorMoseby-Knappe, M.
dc.contributor.authorLang, M.
dc.contributor.authorBellomo, R.
dc.contributor.authorHodgson, C.
dc.contributor.authorMcGuinness, S.
dc.contributor.authorBernard, S.
dc.contributor.authorSkrifvars, M.B.
dc.contributor.authoret al.
dc.date.issued2024
dc.description.abstractBackground Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. Aim The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. Methods We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. Results After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed. Conclusions In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months.
dc.description.statementofresponsibilityGlenn M. Eastwood, Michael Bailey, Alistair D. Nichol, Josef Dankiewicz, Niklas Nielsen, Rachael Parke, Tobias Cronberg, Theresa Olasveengen, Anders M. Grejs, Manuela Iten, Matthias Haenggi, Peter McGuigan, Franca Wagner, Marion Moseby-Knappe, Margareta Lang, Rinaldo Bellomo, On behalf of the TAME trial investigators
dc.identifier.citationAustralian Critical Care, 2024; 38(2):101130-1-101130-8
dc.identifier.doi10.1016/j.aucc.2024.09.015
dc.identifier.issn1036-7314
dc.identifier.issn1036-7314
dc.identifier.orcidDeane, A. [0000-0002-7620-5577]
dc.identifier.urihttps://hdl.handle.net/2440/146296
dc.language.isoen
dc.publisherElsevier
dc.relation.granthttp://purl.org/au-research/grants/nhmrc/1119855
dc.rights© 2024 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/ licenses/by/4.0/).
dc.source.urihttps://doi.org/10.1016/j.aucc.2024.09.015
dc.subjectout-of-hospital cardiac arrest; magnetic resonance imaging; neuroprognostication; post-cardiac arrest care; mortality
dc.subject.meshComa
dc.subject.meshHypercapnia
dc.subject.meshCardiopulmonary Resuscitation
dc.titleMagnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial
dc.typeJournal article
pubs.publication-statusPublished

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