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

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Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication after Cardiac Arrest. / Endisch, Christian; Westhall, Erik; Kenda, Martin; Streitberger, Kaspar J.; Kirkegaard, Hans; Stenzel, Werner; Storm, Christian; Ploner, Christoph J.; Cronberg, Tobias; Friberg, Hans; Englund, Elisabet; Leithner, Christoph.

In: JAMA Neurology, Vol. 77, No. 11, 11.2020, p. 1430-1439.

Research output: Contribution to journalArticle

Harvard

Endisch, C, Westhall, E, Kenda, M, Streitberger, KJ, Kirkegaard, H, Stenzel, W, Storm, C, Ploner, CJ, Cronberg, T, Friberg, H, Englund, E & Leithner, C 2020, 'Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication after Cardiac Arrest', JAMA Neurology, vol. 77, no. 11, pp. 1430-1439. https://doi.org/10.1001/jamaneurol.2020.2340

APA

Endisch, C., Westhall, E., Kenda, M., Streitberger, K. J., Kirkegaard, H., Stenzel, W., Storm, C., Ploner, C. J., Cronberg, T., Friberg, H., Englund, E., & Leithner, C. (2020). Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication after Cardiac Arrest. JAMA Neurology, 77(11), 1430-1439. https://doi.org/10.1001/jamaneurol.2020.2340

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Endisch, Christian ; Westhall, Erik ; Kenda, Martin ; Streitberger, Kaspar J. ; Kirkegaard, Hans ; Stenzel, Werner ; Storm, Christian ; Ploner, Christoph J. ; Cronberg, Tobias ; Friberg, Hans ; Englund, Elisabet ; Leithner, Christoph. / Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication after Cardiac Arrest. In: JAMA Neurology. 2020 ; Vol. 77, No. 11. pp. 1430-1439.

RIS

TY - JOUR

T1 - Hypoxic-Ischemic Encephalopathy Evaluated by Brain Autopsy and Neuroprognostication after Cardiac Arrest

AU - Endisch, Christian

AU - Westhall, Erik

AU - Kenda, Martin

AU - Streitberger, Kaspar J.

AU - Kirkegaard, Hans

AU - Stenzel, Werner

AU - Storm, Christian

AU - Ploner, Christoph J.

AU - Cronberg, Tobias

AU - Friberg, Hans

AU - Englund, Elisabet

AU - Leithner, Christoph

PY - 2020/11

Y1 - 2020/11

N2 - Importance: Neuroprognostication studies are potentially susceptible to a self-fulfilling prophecy as investigated prognostic parameters may affect withdrawal of life-sustaining therapy. Objective: To compare the results of prognostic parameters after cardiac arrest (CA) with the histopathologically determined severity of hypoxic-ischemic encephalopathy (HIE) obtained from autopsy results. Design, Setting, and Participants: In a retrospective, 3-center cohort study of all patients who died following cardiac arrest during their intensive care unit stay and underwent autopsy between 2003 and 2015, postmortem brain histopathologic findings were compared with post-CA brain computed tomographic imaging, electroencephalographic (EEG) findings, somatosensory-evoked potentials, and serum neuron-specific enolase levels obtained during the intensive care unit stay. Data analysis was conducted from 2015 to 2020. Main Outcomes and Measures: The severity of HIE was evaluated according to the selective eosinophilic neuronal death (SEND) classification and patients were dichotomized into categories of histopathologically severe and no/mild HIE. Results: Of 187 included patients, 117 were men (63%) and median age was 65 (interquartile range, 58-74) years. Severe HIE was found in 114 patients (61%) and no/mild HIE was identified in 73 patients (39%). Severe HIE was found in all 21 patients with bilaterally absent somatosensory-evoked potentials, all 15 patients with gray-white matter ratio less than 1.10 on brain computed tomographic imaging, all 9 patients with suppressed EEG, 15 of 16 patients with burst-suppression EEG, and all 29 patients with neuron-specific enolase levels greater than 67 μg/L more than 48 hours after CA without confounders. Three of 7 patients with generalized periodic discharges on suppressed background and 1 patient with burst-suppression EEG had a SEND 1 score (<30% dead neurons) in the cerebral cortex, but higher SEND scores (>30% dead neurons) in other oxygen-sensitive brain regions. Conclusions and Relevance: In this study, histopathologic findings suggested severe HIE after cardiac arrest in patients with bilaterally absent cortical somatosensory-evoked potentials, gray-white matter ratio less than 1.10, highly malignant EEG, and serum neuron-specific enolase concentration greater than 67 μg/L.

AB - Importance: Neuroprognostication studies are potentially susceptible to a self-fulfilling prophecy as investigated prognostic parameters may affect withdrawal of life-sustaining therapy. Objective: To compare the results of prognostic parameters after cardiac arrest (CA) with the histopathologically determined severity of hypoxic-ischemic encephalopathy (HIE) obtained from autopsy results. Design, Setting, and Participants: In a retrospective, 3-center cohort study of all patients who died following cardiac arrest during their intensive care unit stay and underwent autopsy between 2003 and 2015, postmortem brain histopathologic findings were compared with post-CA brain computed tomographic imaging, electroencephalographic (EEG) findings, somatosensory-evoked potentials, and serum neuron-specific enolase levels obtained during the intensive care unit stay. Data analysis was conducted from 2015 to 2020. Main Outcomes and Measures: The severity of HIE was evaluated according to the selective eosinophilic neuronal death (SEND) classification and patients were dichotomized into categories of histopathologically severe and no/mild HIE. Results: Of 187 included patients, 117 were men (63%) and median age was 65 (interquartile range, 58-74) years. Severe HIE was found in 114 patients (61%) and no/mild HIE was identified in 73 patients (39%). Severe HIE was found in all 21 patients with bilaterally absent somatosensory-evoked potentials, all 15 patients with gray-white matter ratio less than 1.10 on brain computed tomographic imaging, all 9 patients with suppressed EEG, 15 of 16 patients with burst-suppression EEG, and all 29 patients with neuron-specific enolase levels greater than 67 μg/L more than 48 hours after CA without confounders. Three of 7 patients with generalized periodic discharges on suppressed background and 1 patient with burst-suppression EEG had a SEND 1 score (<30% dead neurons) in the cerebral cortex, but higher SEND scores (>30% dead neurons) in other oxygen-sensitive brain regions. Conclusions and Relevance: In this study, histopathologic findings suggested severe HIE after cardiac arrest in patients with bilaterally absent cortical somatosensory-evoked potentials, gray-white matter ratio less than 1.10, highly malignant EEG, and serum neuron-specific enolase concentration greater than 67 μg/L.

U2 - 10.1001/jamaneurol.2020.2340

DO - 10.1001/jamaneurol.2020.2340

M3 - Article

C2 - 32687592

AN - SCOPUS:85088423460

VL - 77

SP - 1430

EP - 1439

JO - JAMA Neurology

JF - JAMA Neurology

SN - 2168-6157

IS - 11

ER -