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

Glenn 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; TAME trial investigators

doi:10.1016/j.aucc.2024.09.015

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

Aust Crit Care. 2024 Nov 7:101130. doi: 10.1016/j.aucc.2024.09.015. Online ahead of print.

Authors

Glenn M Eastwood¹, Michael Bailey², Alistair D Nichol³, Josef Dankiewicz⁴, Niklas Nielsen⁵, Rachael Parke⁶, Tobias Cronberg⁷, Theresa Olasveengen⁸, Anders M Grejs⁹, Manuela Iten¹⁰, Matthias Haenggi¹¹, Peter McGuigan¹², Franca Wagner¹³, Marion Moseby-Knappe¹⁴, Margareta Lang¹⁵, Rinaldo Bellomo¹⁶; TAME trial investigators

Collaborators

TAME trial investigators:
Carol Hodgson, Shay McGuinness, Stephen Bernard, Markus B Skrifvars, Dion Stub, Fabio S Taccone, John Archer, Demetrios Kutsogiannis, Gisela Lilja, Hans Kirkegaard, Gilles Capellier, Giovanni Landoni, Janneke Horn, Yaseen Arabi, Yew Woon Chia, Andrej Markota, Matt P Wise, Steffen Christensen, Heidi Munk-Andersen, Asger Granfeldt, Geir Ø Andersen, Eirik Qvigstad, Arnljot Flaa, Matthew Thomas, Katie Sweet, Jeremy Bewley, Minna Bäcklund, Marjaana Tiainen, Anja Levis, Leah Peck, James Walsham, Adam Deane, Angajendra Ghosh, Filippo Annoni, Yan Chen, David Knight, Eden Lesona, Haytham Tlayjeh, Franc Svenšek, Jade Cole, David Pogson, Matthias P Hilty, Joachim P Düring, Eldho Paul, Bridget Ady, Kate Ainscough, Anna Hunt, Sinéad Monahan, Tony Trapani, Ciara Fahey

Affiliations

¹ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia. Electronic address: glenn.eastwood@austin.org.au.
² Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
³ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; University College Dublin Clinical Research Centre at St Vincents University Hospital, Dublin, Ireland.
⁴ Department of Clinical Sciences Lund, Section of Cardiology, Skåne University Hospital and Lund University, Sweden.
⁵ Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Sweden; Department of Anesthesiology and Intensive Care, Helsingborg Hospital, Helsingborg, Sweden.
⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Cardiothoracic and Vascular Intensive Care Unit, Auckland City Hospital, Te Toka Tumai Auckland, Auckland, New Zealand; School of Nursing, The University of Auckland, Auckland, New Zealand; Medical Research Institute of New Zealand, Wellington, New Zealand.
⁷ Head of Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Sweden; Skåne University Hospital, Sweden.
⁸ Department of Anaesthesia and Intensive Care, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Norway.
⁹ Department of Intensive Care Medicine, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
¹⁰ Department of Intensive Care Medicine, Inselspital University Hospital Bern, Bern, Switzerland.
¹¹ Institute of Intensive Care Medicine, University Hospital Zurich, Zurich, Switzerland.
¹² Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, United Kingdom.
¹³ University Institute of Diagnostic and Interventional Neuroradiology, Inselspital University Hospital Bern, and University of Bern, Bern, Switzerland.
¹⁴ Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Neurology and Rehabilitation, Skåne University Hospital, Lund, Sweden.
¹⁵ Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Department of Radiology, Helsingborg Hospital, Helsingborg, Sweden.
¹⁶ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Australia; Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia.

PMID: 39516151
DOI: 10.1016/j.aucc.2024.09.015

Abstract

Background: 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.

Keywords: Magnetic resonance imaging; Mortality; Neuroprognostication; Out-of-hospital cardiac arrest; Post–cardiac arrest care.