Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices

doi:10.1016/j.pediatrneurol.2022.06.011

. 2022 Sep:134:45-51.

doi: 10.1016/j.pediatrneurol.2022.06.011. Epub 2022 Jun 20.

Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices

Juan A Piantino¹, Christopher M Ruzas², Craig A Press³, Subramanian Subramanian⁴, Binod Balakrishnan⁵, Ashok Panigrahy⁴, David Pettersson⁶, John A Maloney⁷, Arastoo Vossough⁸, Alexis Topjian⁹, Matthew P Kirschen⁹, Lesley Doughty¹⁰, Melissa G Chung¹¹, David Maloney¹², Tamara Haller¹³, Anthony Fabio¹³, Ericka L Fink¹⁴; POCCA Investigators

Collaborators, Affiliations

Collaborators

POCCA Investigators:
Patrick Kochanek, Robert Clark, Hulya Bayir, Ashok Panigrahy, Rachel Berger, Sue Beers, Tony Fabio, Karen Walson, Alexis Topjian, Christopher J L Newth, Elizabeth Hunt, Jordan Duval-Arnould, Binod Balakrishnan, Michael T Meyer, Melissa G Chung, Anthony Willyerd, Lincoln Smith, Jesse Wenger, Stuart Friess, Jose Pineda, Ashley Siems, Jason Patregnani, John Diddle, Aline Maddux, Craig Press, Lesley Doughty, Juan Piantino, David Maloney, Pamela Rubin, Beena Desai, Maureen G Richardson, Cynthia Bates, Darshana Parikh, Janice Prodell, Maddie Winters, Katherine Smith, Jeni Kwok, Adriana Cabrales, Ronke Adewale, Pam Melvin, Sadaf Shad, Katherine Siegel, Katherine Murkowski, Mary Kasch, Josey Hensley, Lisa Steele, Danielle Brown, Brian Burrows, Lauren Hlivka, Deana Rich, Amila Tutundzic, Tina Day, Lori Barganier, Ashley Wolfe, Mackenzie Little, Elyse Tomanio, Neha Patel, Diane Hession, Yamila Sierra, Rhonda Jones, Laura Benken, Jonathan Elmer, Subramanian Subramanian, Srikala Narayanan, Julia Wallace, Tami Robinson, Andrew Frank, Stefan Bluml, Jessica Wisnowski, Keri Feldman, Avinash Vemulapalli, Linda Ryan, Scott Szypulski

Affiliations

¹ Division of Child Neurology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
² Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
³ Division of Neurology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁴ Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
⁶ Division of Neuroradiology, Department of Diagnostic Radiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
⁷ Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
⁸ Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁹ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
¹⁰ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
¹¹ Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
¹² Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
¹³ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹⁴ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: finkel@ccm.upmc.edu.

PMID: 35835025
PMCID: PMC9883065
DOI: 10.1016/j.pediatrneurol.2022.06.011

Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices

Juan A Piantino et al. Pediatr Neurol. 2022 Sep.

. 2022 Sep:134:45-51.

doi: 10.1016/j.pediatrneurol.2022.06.011. Epub 2022 Jun 20.

Authors

Collaborators

POCCA Investigators:
Patrick Kochanek, Robert Clark, Hulya Bayir, Ashok Panigrahy, Rachel Berger, Sue Beers, Tony Fabio, Karen Walson, Alexis Topjian, Christopher J L Newth, Elizabeth Hunt, Jordan Duval-Arnould, Binod Balakrishnan, Michael T Meyer, Melissa G Chung, Anthony Willyerd, Lincoln Smith, Jesse Wenger, Stuart Friess, Jose Pineda, Ashley Siems, Jason Patregnani, John Diddle, Aline Maddux, Craig Press, Lesley Doughty, Juan Piantino, David Maloney, Pamela Rubin, Beena Desai, Maureen G Richardson, Cynthia Bates, Darshana Parikh, Janice Prodell, Maddie Winters, Katherine Smith, Jeni Kwok, Adriana Cabrales, Ronke Adewale, Pam Melvin, Sadaf Shad, Katherine Siegel, Katherine Murkowski, Mary Kasch, Josey Hensley, Lisa Steele, Danielle Brown, Brian Burrows, Lauren Hlivka, Deana Rich, Amila Tutundzic, Tina Day, Lori Barganier, Ashley Wolfe, Mackenzie Little, Elyse Tomanio, Neha Patel, Diane Hession, Yamila Sierra, Rhonda Jones, Laura Benken, Jonathan Elmer, Subramanian Subramanian, Srikala Narayanan, Julia Wallace, Tami Robinson, Andrew Frank, Stefan Bluml, Jessica Wisnowski, Keri Feldman, Avinash Vemulapalli, Linda Ryan, Scott Szypulski

Affiliations

¹ Division of Child Neurology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
² Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
³ Division of Neurology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁴ Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin.
⁶ Division of Neuroradiology, Department of Diagnostic Radiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon.
⁷ Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado.
⁸ Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
⁹ Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
¹⁰ Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
¹¹ Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
¹² Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
¹³ Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania.
¹⁴ Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. Electronic address: finkel@ccm.upmc.edu.

PMID: 35835025
PMCID: PMC9883065
DOI: 10.1016/j.pediatrneurol.2022.06.011

Abstract

Background: Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA.

Methods: A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support.

Results: Response rate was 31% (44 of 143). Thirty-four percent (15 of 44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22 of 44) of respondents reported that an MRI is obtained in nearly all patients with CA, and 32% (14 of 44) obtain an MRI in those who do not return to baseline neurological status. Poor neurological examination was reported as the most common factor (91% [40 of 44]) determining the timing of the MRI. Conventional sequences (T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted imaging/apparent diffusion coefficient) are routinely used at greater than 97% of centers. Use of advanced imaging techniques (magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI) were reported by less than half of centers.

Conclusions: Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.

Keywords: Brain; Cardiac arrest; Child; Hypoxia-ischemia; MRI; Neuroimaging; Surveys and questionnaires.

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Conflict of interest statement

Declarations of Interest: Dr. Fink receives funding from National Institute of Neurological Disorders and Stroke (NINDS) R01NS096714 and Neurocritical Care Society Incline Grant.

Dr. Piantino receives support from the National Institute of Health, National Heart, Lung, and Blood Institute, grant K23HL150217.

Dr. Press has performed paid expert testimony and provides consulting for Marinus Pharmaceuticals.

The remaining authors have no relevant interests to disclose.

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References

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1. Berg RA, Sutton RM, Holubkov R, et al. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med. 2013;41:2292–2297. - PMC - PubMed
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[1] Atkins DL, Everson-Stewart S, Sears GK, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the resuscitation outcomes consortium epistry-cardiac arrest. Circulation. 2009;119:1484–1491. - PMC - PubMed

[2] Atkins DL, Everson-Stewart S, Sears GK, et al. Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the resuscitation outcomes consortium epistry-cardiac arrest. Circulation. 2009;119:1484–1491. - PMC - PubMed

[3] Topjian AA, Berg RA. Pediatric out-of-hospital cardiac arrest. Circulation. 2012;125:2374–2378. - PubMed

[4] Topjian AA, Berg RA. Pediatric out-of-hospital cardiac arrest. Circulation. 2012;125:2374–2378. - PubMed

[5] Berg RA, Sutton RM, Holubkov R, et al. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med. 2013;41:2292–2297. - PMC - PubMed

[6] Berg RA, Sutton RM, Holubkov R, et al. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med. 2013;41:2292–2297. - PMC - PubMed

[7] Knudson JD, Neish SR, Cabrera AG, et al. Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids’ Inpatient Database. Crit Care Med. 2012;40:2940–2944. - PubMed

[8] Knudson JD, Neish SR, Cabrera AG, et al. Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids’ Inpatient Database. Crit Care Med. 2012;40:2940–2944. - PubMed

[9] Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes. 2013;6:42–49. - PMC - PubMed

[10] Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes. 2013;6:42–49. - PMC - PubMed

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Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices

Collaborators

Affiliations

Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices

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Abstract

Conflict of interest statement

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