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

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