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Prognostic Value of Brain Magnetic Resonance Imaging in Children After Out-of-Hospital Cardiac Arrest: Predictive
Marijn Albrecht1, Rogier de Jonge1, Corinne Buysse1
1Division of Pediatric Intensive Care, Department of Neonatal and Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Brain MRI within seven days of pediatric out-of-hospital cardiac arrest (OHCA) effectively predicts long-term outcomes. Normal findings indicate favorable recovery, while extensive injury predicts poor outcomes or death.
Area of Science:
- Pediatric critical care medicine
- Neuroimaging
- Neurology
Background:
- Assessing long-term outcomes after pediatric out-of-hospital cardiac arrest (OHCA) is crucial.
- Brain magnetic resonance imaging (MRI) is a key diagnostic tool.
Purpose of the Study:
- To determine the predictive value of early brain MRI findings (≤7 days) post-pediatric OHCA for long-term neurological outcomes.
- To establish the prognostic significance of neuroimaging in pediatric cardiac arrest survivors.
Main Methods:
- Retrospective single-center study of children (0-17 years) with OHCA (2012-2020).
- Brain MRI (T1, T2, diffusion-weighted) analyzed using a novel scoring system within 7 days post-arrest.
- Extensive injury defined as ≥50% cortex/white matter damage or involvement of ≥4 brain regions.
- Neurological outcomes assessed via Pediatric Cerebral Performance Category (PCPC) scores at discharge and 2 years post-OHCA.
Main Results:
- 56 of 142 pediatric OHCA patients underwent early brain MRI (median 4 days post-arrest).
- Normal MRI findings demonstrated 100% negative predictive value for favorable outcomes.
- Extensive brain injury on MRI showed 100% positive predictive value for unfavorable outcomes or death.
Conclusions:
- Early brain MRI (≤7 days) is a highly accurate predictor of long-term neurological outcomes in pediatric OHCA survivors.
- A normal MRI reliably predicts favorable outcomes, while significant injury predicts poor prognosis at 2 years.
- Neuroimaging findings provide critical prognostic information for guiding post-arrest care and follow-up.
Background:
Determine the predictive value of brain magnetic resonance imaging (MRI) findings less than or equal to seven days post-pediatric out-of-hospital cardiac arrest (OHCA) for long-term outcomes.
Methods:
This retrospective single-center study included children (zero to 17 years) with OHCA admitted to a tertiary care hospital pediatrc intensive care unit from 2012 to 2020 who underwent brain MRI at most seven days postarrest. A neuroimaging scoring system was designed, using T1-, T2-, and diffusion-weighted images based on previously published scores and brain injury patterns. Extensive brain injury was defined as ≥50% cortex/white matter injury or four or more of nine predefined brain regions. Pediatric cerebral performance category (PCPC) scores were determined at hospital discharge and two years post-OHCA as part of routine follow-up care. Favorable neurological outcomes were defined as PCPC scores of 1 to 2 or no change from prearrest status.
Results:
Among 142 children, 56 had a brain MRI at less than or equal to seven days postarrest. Median arrest age was 3.3 years (first and third quartiles [Q1, Q3]: 0.6, 13.6), and 64% were male. Brain MRI was obtained four days post-OHCA (Q1, Q3: 3, 5). Normal brain MRI findings (i.e., negative test result) predicted favorable outcomes with 100% negative predictive value, whereas extensive injury (i.e., positive test result) predicted unfavorable outcomes and death with 100% positive predictive value.
Conclusions:
A normal brain MRI at less than or equal to seven days postarrest predicts favorable neurological outcomes two years later, whereas extensive brain injury predicts unfavorable neurological outcomes or death at discharge and two years post-OHCA.
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