Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication After Cardiac Arrest

Christian Endisch ¹, Erik Westhall ², Martin Kenda ¹

⁰AG Emergency and Critical Care Neurology, Campus Virchow Klinikum, Department of Neurology, Charité Universitätsmedizin Berlin, Berlin, Germany.

Jama Neurology +

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July 21, 2020

View abstract on PubMed

Summary

Histopathology confirms severe hypoxic-ischemic encephalopathy (HIE) after cardiac arrest (CA) in patients with absent somatosensory-evoked potentials, specific CT findings, malignant EEG, or high neuron-specific enolase levels.

Area Of Science

Neurology
Pathology
Critical Care Medicine

Background

Neuroprognostication after cardiac arrest (CA) can be influenced by treatment decisions.
Accurate prediction of neurological outcome is crucial for guiding patient care.

Purpose Of The Study

To compare clinical prognostic parameters with postmortem histopathological findings of hypoxic-ischemic encephalopathy (HIE).
To validate the accuracy of neuroimaging, electroencephalography (EEG), and biomarkers in predicting HIE severity post-CA.

Main Methods

Retrospective analysis of 187 patients who died after CA and underwent autopsy.
Comparison of autopsy-derived HIE severity (SEND classification) with pre-mortem data: CT imaging, EEG, somatosensory-evoked potentials (SSEPs), and neuron-specific enolase (NSE).

Main Results

Severe HIE correlated strongly with absent SSEPs, a gray-white matter ratio <1.10 on CT, suppressed or burst-suppression EEG patterns, and NSE levels >67 μg/L.
Most patients with these clinical indicators showed severe HIE, though some had less severe cortical injury with more severe injury in other brain regions.

Conclusions

Histopathological findings support the use of absent SSEPs, specific CT findings, malignant EEG, and elevated NSE as reliable indicators of severe HIE post-CA.
These validated parameters can aid in accurate neuroprognostication, potentially mitigating the self-fulfilling prophecy in critical care decisions.