Abstract Details

Title Invasive neuromonitoring predicts awakening after diffuse hypoxic ischemic brain injury

Topic Neurocritical Care

Presentation(s) N2 - Neuroscience in the Clinic: Multimodal Tools for Cardiac Arrest Neuroprognostication (2:20 PM-2:35 PM)

Poster/Presentation
Number 001

Objective To determine if invasive neuromonitoring (INM) predicts return of consciousness in patients with hypoxic ischemic brain injury (HIBI).

Background Neuroprognostication after HIBI is challenging. INM measures physiological parameters, such as intracranial pressure (ICP) and interstitial brain tissue oxygen (P_btO₂) that can be used to guide therapy after severe brain injury. However, the ability of INM to predict outcome after HIBI is unclear.

Design/Methods

This retrospective observational study analyzed 37 patients with HIBI who underwent INM between April 2015-December 2018. Awakening was defined as return to a Glasgow Coma Scale motor score of 6. Average ICP, P_btO₂, and Pressure Reactivity Index (PRx, a moving linear correlation coefficient between ICP and mean arterial pressure) was calculated for all patients, and differences between patients with and without awakening were analyzed using Wilcoxon Rank Sum test. We used Receiver Operating Characteristic (ROC) analysis to identify optimal cutoffs for ICP, PRx and P_btO₂ that predicted awakening.

Results 36 of 37 patients had usable data. Of these 36, 33 had cardiac arrest while 3 had prolonged hypoxia. 8 patients had awakening and were discharged to a rehabilitation facility, while 28 either died or were discharged in an unresponsive state to a long-term care facility. Patients with awakening had markedly lower PRx (0.099 vs. 0.52, p<0.0001) and ICP (6.98 vs. 18.98 mmHg, p= 0.0019) compared to those that died or remained unresponsive. Average PbtO2 was not different between groups (24.29 vs. 21.81 mmHg, p=0.7160). PRx<0.2 and ICP<12 mmHg both predicted awakening with high sensitivity and specificity. Combining PRx and ICP thresholds improved specificity but not sensitivity.

Conclusions

Average ICP and PRx correlate with return of consciousness after hypoxic ischemic brain injury. Future studies are needed to validate these preliminary findings.

Authors/Disclosures
Swarna Rajagopalan, MD (Cooper University Healthcare) PRESENTER	Dr. Rajagopalan has nothing to disclose.
Matthew Kirschen, MD, PhD, FAAN	The institution of Dr. Kirschen has received research support from NIH.
Matthew Kirschen, MD, PhD, FAAN	The institution of Dr. Kirschen has received research support from NIH.
	No disclosure on file
Ram Balu, MD	Dr. Balu has nothing to disclose.

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