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American Heart Association

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Final ID: Su902

Ability of Composite Magnetic Resonance Brain Imaging Scores to Predict Functional Outcomes in Survivors of Cardiac Arrest

Abstract Body: Background: Brain magnetic resonance imaging (MRI) has been examined for neuroprognostication (NP) after out-of-hospital cardiac arrest (OHCA). However, studies have focused on predicting poor outcomes of non-awakening and/or death. Recommendations for utilization of brain MRI in NP remain weak due to its subjective interpretation.

Aim: We modified a previously published brain MRI score and examined our quantitated NP scores’ ability to predict good functional outcomes in OHCA survivors.

Methods: We screened OHCA cases (2017-2023, Seattle Medic One registry) for patients who survived to hospital discharge and had brain MRIs performed 25 hours-7 days after arrest. Each MRI was reviewed by two adjudicators; a third reviewer served as tie-breaker. Reviewers were blinded to patient outcomes. Diffusion Weighted Imaging and Fluid Attenuated Inversion Recovery sequences were reviewed to score 35 neuroanatomical regions. Graded severity for estimated affected area (0 = zero; 1= < 25%; 2 = 25-50%; 3 = 50-75%; 4 = >75%) and binary (0 = not affected, 1 = affected) scores were tallied. Points were summed for a composite brain MRI score, “NP score”, possible range 0-214. Primary outcome was Cerebral Performance Categories (CPC) at hospital discharge (1-2: “independent”, 3: “dependent”, 4: “vegetative state”). Computational modeling employed folded normal distributions and Maximum Likelihood Estimation. Statistical analyses were Pearson’s, Spearman’s, ANOVA, Fisher LSD, t-tests.

Results: Forty-two (42) adult patients were included (74% men, 55% Caucasian). Median NP score was 11.5 (IQR 41.5, n=42) overall, 2 (IQR=10, n=21) for independent versus 25.5 (IQR 36.5, n=10) for dependent patients, and 92 (IQR=81, n=11) for those in a vegetative state. NP scores strongly correlated with CPC [rs (40) = .69, p< .001], and were significantly different between CPC groups [F(2,39) = 32.66, p< 0.001]. Interrater concordance for NP score was high (Pearson) r = .88 [r = .96; .95; .90; .71].

Conclusions: Our NP score correlated well with good functional outcomes in OHCA survivors, and (1) identified distinct thresholds that well-separate functional outcome groups and (2) had very strong concordance rate among four pairs of adjudicators. NP score-based predictive modeling differentiates functional outcomes beyond good versus poor dichotomy and may help providers and family anticipate recovery potential.
  • Nguyen, Thuhien  ( University of Washington , Seattle , Washington , United States )
  • Town, James  ( Harborview Medical Center , Seattle , Washington , United States )
  • Wahlster, Sarah  ( University of Washington , Seattle , Washington , United States )
  • Johnson, Nicholas  ( University of Washington , Seattle , Washington , United States )
  • Poilvert, Nicolas  ( Caption Health, Inc. , Seattle , Washington , United States )
  • Lin, Victor  ( University of Washington , Seattle , Washington , United States )
  • Ukatu, Hope  ( University of Washington , Seattle , Washington , United States )
  • Matin, Nassim  ( Barrow Neurological Institute , Phoenix , Arizona , United States )
  • Davis, Arielle  ( UNIVERSITY WASHINGTON , Seattle , Washington , United States )
  • Taylor, Breana  ( University of Washington , Seattle , Washington , United States )
  • Thomas, Penelope  ( University of Washington , Seattle , Washington , United States )
  • Sharma, Monisha  ( University of Washington , Seattle , Washington , United States )
  • Author Disclosures:
    Thuhien Nguyen: DO NOT have relevant financial relationships | James Town: DO NOT have relevant financial relationships | Sarah Wahlster: No Answer | Nicholas Johnson: DO have relevant financial relationships ; Advisor:Neuroptics, Inc:Active (exists now) | Nicolas Poilvert: DO NOT have relevant financial relationships | Victor Lin: DO have relevant financial relationships ; Researcher:Marinus Pharmaceuticals:Past (completed) | Hope Ukatu: No Answer | Nassim Matin: No Answer | Arielle Davis: DO NOT have relevant financial relationships | Breana Taylor: No Answer | Penelope Thomas: No Answer | Monisha Sharma: No Answer
Meeting Info:

Resuscitation Science Symposium

2024

Chicago, Illinois

Session Info:

ReSS24 Poster Session 209: Outcome prediction models

Sunday, 11/17/2024 , 01:15PM - 02:45PM

ReSS24 Poster Session and Reception

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