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Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial

Eastwood, G.M. ; Dankiewicz, J. LU orcid ; Nielsen, N. LU orcid ; Moseby-Knappe, M. LU ; Lang, M. LU and C., Fahey (2025) In Australian Critical Care 38(2).
Abstract
Background: Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. Aim: The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. Methods: We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. Results: After exclusions, 1639 patients enrolled in the TAME trial... (More)
Background: Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. Aim: The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. Methods: We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. Results: After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p < 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p < 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p < 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p < 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed. Conclusions: In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months. © 2024 Australian College of Critical Care Nurses Ltd (Less)
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; ; ; ; and
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Magnetic resonance imaging, Mortality, Neuroprognostication, Out-of-hospital cardiac arrest, Post–cardiac arrest care
in
Australian Critical Care
volume
38
issue
2
article number
101130
publisher
Elsevier
external identifiers
  • scopus:85208558528
  • pmid:39516151
ISSN
1036-7314
DOI
10.1016/j.aucc.2024.09.015
language
English
LU publication?
yes
id
e72d4e1c-a818-4d12-9a5b-3dab6eba52ca
date added to LUP
2025-10-15 13:25:07
date last changed
2025-10-16 03:00:12
@article{e72d4e1c-a818-4d12-9a5b-3dab6eba52ca,
  abstract     = {{Background: Neuroimaging with magnetic resonance imaging (MRI) may assist clinicians in evaluating brain injury and optimising care in comatose adults resuscitated after out-of-hospital cardiac arrest (OHCA). However, contemporary international data on its use are lacking. Aim: The primary aim was to compare the patient characteristics, early postresuscitation care, and neurological outcomes of patients according to MRI use. Methods: We performed a posthoc analysis of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest (TAME) trial, a multinational randomised trial comparing targeted mild hypercapnia or normocapnia in comatose adults after OHCA. Results: After exclusions, 1639 patients enrolled in the TAME trial were analysed. Of these, 149 (9%) had an MRI. Compared to non-MRI patients, MRI patients were younger (58.9 versus 61.7 years, p: 0.02), had a longer median time from OHCA to return of spontaneous circulation (30 versus 25 min, p &lt; 0.0001), and had a higher average arterial lactate level (8.78 versus 6.74 mmol/L, p &lt; 0.0001) on admission to hospital. MRI patients were more likely to receive additional advanced diagnostic assessments during intensive care unit admission (p &lt; 0.0001). At 6 months, 23 of 140 patients (16.4%) in the MRI group had a favourable neurological outcome, compared with 659 of 1399 patients (47.1%) in the no-MRI group (p &lt; 0.001). On multivariable modelling, country of enrolment was the dominating predictor in the likelihood of an MRI being performed. Conclusions: In the TAME trial, 9% of patients had an MRI during their intensive care unit admission. Among these patients, only 16% had a favourable neurological outcome at 6 months. © 2024 Australian College of Critical Care Nurses Ltd}},
  author       = {{Eastwood, G.M. and Dankiewicz, J. and Nielsen, N. and Moseby-Knappe, M. and Lang, M. and C., Fahey}},
  issn         = {{1036-7314}},
  keywords     = {{Magnetic resonance imaging; Mortality; Neuroprognostication; Out-of-hospital cardiac arrest; Post–cardiac arrest care}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{Elsevier}},
  series       = {{Australian Critical Care}},
  title        = {{Magnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial}},
  url          = {{http://dx.doi.org/10.1016/j.aucc.2024.09.015}},
  doi          = {{10.1016/j.aucc.2024.09.015}},
  volume       = {{38}},
  year         = {{2025}},
}