Increased task-relevant fMRI responsiveness in comatose cardiac arrest patients is associated with improved neurologic outcomes
Year: 2023
Type: article
Study design: Observational Study
Abstract: Early prediction of the recovery of consciousness in comatose cardiac arrest patients remains challenging. We prospectively studied task-relevant fMRI responses in 19 comatose cardiac arrest patients and five healthy controls to assess the fMRI’s utility for neuroprognostication. Tasks involved instrumental music listening, forward and backward language listening, and motor imagery. Task-specific reference images were created from group-level fMRI responses from the healthy controls. Dice scores measured the overlap of individual subject-level fMRI responses with the reference images. Task-relevant responsiveness index (Rindex) was calculated as the maximum Dice score across the four tasks. Correlation analyses showed that increased Dice scores were significantly associated with arousal recovery ( P < 0.05 ) and emergence from the minimally conscious state (EMCS) by one year ( P < 0.001 ) for all tasks except motor imagery. Greater Rindex was significantly correlated with improved arousal recovery (P = 0.002) and consciousness (P = 0.001). For patients who survived to discharge ( n = 6 ), the Rindex’s sensitivity was 75% for predicting EMCS (n = 4). Task-based fMRI holds promise for detecting covert consciousness in comatose cardiac arrest patients, but further studies are needed to confirm these findings. Caution is necessary when interpreting the absence of task-relevant fMRI responses as a surrogate for inevitable poor neurological prognosis.
Authors: Kiran Dhakal, Eric S Rosenthal, Annelise M Kulpanowski, Jacob A Dodelson, Zihao Wang, Gaston Cudemus-Deseda, Marjorie Villien, Brian L Edlow, Alexander M Presciutti, James L Januzzi, MingMing Ning, W Taylor Kimberly, Edilberto Amorim, M Brandon Westover, William A Copen, Pamela W Schaefer, Joseph T Giacino, David M Greer, Ona Wu
Language: English
Subfield: Emergency Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: American Heart Association, Massachusetts General Hospital, Centre d'Imagerie BioMédicale, National Institutes of Health, Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, National Institute on Aging, National Institute of Neurological Disorders and Stroke, Eunice Kennedy Shriver National Institute of Child Health and Human Development
Awards: G122882294, Multimodal Network Connectivity Architecture (MOCA) of the Brain and its Role in the Recovery of Consciousness in Comatose Cardiac Arrest Patients, G2688528023, G4193620056, A Connectome-Based Clinical Trial Platform to Promote Early Recovery of Consciousness after Traumatic Coma, G5340433987, Investigation of Sleep, Automated detection of severe brain edema development in cardiac arrest survivors, Proteomic Profiling of Patent Foramen Ovale Related Neurovascular Injury, Prospective Validation of Neurophysiologic Outcome Prediction in Acute Brain Injury
OpenAlex ID: W4386878328