Skip to main content
Erschienen in: Neurocritical Care 3/2014

01.06.2014 | Original Article

MRI Default Mode Network Connectivity is Associated with Functional Outcome After Cardiopulmonary Arrest

verfasst von: Matthew A. Koenig, John L. Holt, Thomas Ernst, Steven D. Buchthal, Kazuma Nakagawa, Victor A. Stenger, Linda Chang

Erschienen in: Neurocritical Care | Ausgabe 3/2014

Einloggen, um Zugang zu erhalten

Abstract

Background

We hypothesized that the degree of preserved functional connectivity within the DMN during the first week after cardiopulmonary arrest (CPA) would be associated with functional outcome at hospital discharge.

Methods

Initially comatose CPA survivors with indeterminate prognosis at 72 h were enrolled. Seventeen CPA subjects between 4 and 7 days after CPA and 17 matched controls were studied with task-free fMRI. Independent component analysis was performed to delineate the DMN. Connectivity strength in the DMN was compared between CPA subjects and controls, as well as between CPA subjects with good outcome (discharge Cerebral Performance Category or CPC 1–2) and those with bad outcome (CPC 3–5). The relationship between connectivity strength in the posterior cingulate cortex (PCC) and precuneus (PC) within the DMN with discharge CPC was evaluated using linear regression.

Results

Compared to controls, CPA subjects had significantly lower connectivity strength in subregions of the DMN, the PCC and PC (p < 0.0001). Furthermore, connectivity strength in the PCC and PC was greater in CPA subjects with good outcome (n = 8) than those with bad outcome (n = 9) (p < 0.003). Among CPA subjects, the connectivity strength in the PCC and PC showed strong linear correlations with the discharge CPC (p < 0.005).

Conclusions

Among initially comatose CPA survivors with indeterminate prognosis, task-free fMRI demonstrated graded disruption of DMN connectivity, especially in those with bad outcomes. If confirmed, connectivity strength in the PC/PCC may provide a clinically useful prognostic marker for functional recovery after CPA.
Literatur
1.
Zurück zum Zitat Bedell SE, Delbanco TL, Cook EF, Epstein EF. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569–76.PubMedCrossRef Bedell SE, Delbanco TL, Cook EF, Epstein EF. Survival after cardiopulmonary resuscitation in the hospital. N Engl J Med. 1983;309:569–76.PubMedCrossRef
2.
Zurück zum Zitat Edgren E, Kelsey S, Sutton K, Safar P. The presenting ECG pattern in survivors of cardiac arrest and its relation to the subsequent long-term survival. Brain Resuscitation Clinical Trial I Study Group. Acta Aneasthesiol Scand. 1989;33:265–71.CrossRef Edgren E, Kelsey S, Sutton K, Safar P. The presenting ECG pattern in survivors of cardiac arrest and its relation to the subsequent long-term survival. Brain Resuscitation Clinical Trial I Study Group. Acta Aneasthesiol Scand. 1989;33:265–71.CrossRef
3.
Zurück zum Zitat Berek K, Jeschow M, Aichner F. The prognostication of cerebral hypoxia after out-of-hospital cardiac arrest in adults. Eur Neurol. 1997;37:135–45.PubMedCrossRef Berek K, Jeschow M, Aichner F. The prognostication of cerebral hypoxia after out-of-hospital cardiac arrest in adults. Eur Neurol. 1997;37:135–45.PubMedCrossRef
4.
Zurück zum Zitat Nichol G, Stiell IG, Herbert P, Wells GA, Vandemheen K, Laupacis A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999;6:95–102.PubMedCrossRef Nichol G, Stiell IG, Herbert P, Wells GA, Vandemheen K, Laupacis A. What is the quality of life for survivors of cardiac arrest? A prospective study. Acad Emerg Med. 1999;6:95–102.PubMedCrossRef
5.
Zurück zum Zitat Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome. Epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on resuscitation. Circulation. 2008;118:2452–83.PubMedCrossRef Neumar RW, Nolan JP, Adrie C, et al. Post-cardiac arrest syndrome. Epidemiology, pathophysiology, treatment, and prognostication. A consensus statement from the International Liaison Committee on resuscitation. Circulation. 2008;118:2452–83.PubMedCrossRef
6.
Zurück zum Zitat Wijdicks EFM, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Neurology. 2006;67:203–10.PubMedCrossRef Wijdicks EFM, Hijdra A, Young GB, Bassetti CL, Wiebe S. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review). Neurology. 2006;67:203–10.PubMedCrossRef
7.
Zurück zum Zitat Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med. 2003;348:2626–33.PubMedCrossRef Bunch TJ, White RD, Gersh BJ, et al. Long-term outcomes of out-of-hospital cardiac arrest after successful early defibrillation. N Engl J Med. 2003;348:2626–33.PubMedCrossRef
8.
Zurück zum Zitat van Alem AP, de Vos R, Schmand B, Koster RW. Cognitive impairment in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148:416–21.PubMedCrossRef van Alem AP, de Vos R, Schmand B, Koster RW. Cognitive impairment in survivors of out-of-hospital cardiac arrest. Am Heart J. 2004;148:416–21.PubMedCrossRef
9.
Zurück zum Zitat Moulaert VRMP, Verbunt JA, van Heugten CM, Wade DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2009;80:297–305.PubMedCrossRef Moulaert VRMP, Verbunt JA, van Heugten CM, Wade DT. Cognitive impairments in survivors of out-of-hospital cardiac arrest: a systematic review. Resuscitation. 2009;80:297–305.PubMedCrossRef
10.
Zurück zum Zitat Wijdicks EF, Campeau NG, Miller GM. MR imaging in comatose survivors of cardiac resuscitation. Am J Neuroradiol. 2001;22:1561–5.PubMed Wijdicks EF, Campeau NG, Miller GM. MR imaging in comatose survivors of cardiac resuscitation. Am J Neuroradiol. 2001;22:1561–5.PubMed
11.
Zurück zum Zitat Els T, Kassubek J, Kubalek R, Klisch J. Diffusion-weighted MRI during early global cerebral hypoxia: a predictor for clinical outcome? Acta Neurol Scand. 2004;110:361–7.PubMedCrossRef Els T, Kassubek J, Kubalek R, Klisch J. Diffusion-weighted MRI during early global cerebral hypoxia: a predictor for clinical outcome? Acta Neurol Scand. 2004;110:361–7.PubMedCrossRef
12.
13.
Zurück zum Zitat Laureys S, Faymonville ME, Peigneux P, et al. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage. 2002;17:732–41.PubMedCrossRef Laureys S, Faymonville ME, Peigneux P, et al. Cortical processing of noxious somatosensory stimuli in the persistent vegetative state. Neuroimage. 2002;17:732–41.PubMedCrossRef
14.
Zurück zum Zitat Schiff ND, Rodriguez-Moreno D, Kamel A, et al. fMRI reveals large-scale network activation in minimally conscious patients. Neurology. 2005;64:514–23.PubMedCrossRef Schiff ND, Rodriguez-Moreno D, Kamel A, et al. fMRI reveals large-scale network activation in minimally conscious patients. Neurology. 2005;64:514–23.PubMedCrossRef
15.
Zurück zum Zitat Biswal B, Yetkin FZ, Haughton VM, Hyde JS. Functional connectivity in the motor cortex of resting human brain using echo-planar MRI. Magn Reson Med. 1995;34:537–41.PubMedCrossRef Biswal B, Yetkin FZ, Haughton VM, Hyde JS. Functional connectivity in the motor cortex of resting human brain using echo-planar MRI. Magn Reson Med. 1995;34:537–41.PubMedCrossRef
16.
Zurück zum Zitat Hampson M, Peterson BS, Skudlarski P, Gatenby JC, Gore JC. Detection of functional connectivity using temporal correlations in MR images. Hum Brain Mapp. 2002;15:513–9.CrossRef Hampson M, Peterson BS, Skudlarski P, Gatenby JC, Gore JC. Detection of functional connectivity using temporal correlations in MR images. Hum Brain Mapp. 2002;15:513–9.CrossRef
17.
Zurück zum Zitat Schiff ND. Multimodal neuroimaging approaches to disorders of consciousness. J Head Trauma Rehabil. 2006;21:388–97.PubMedCrossRef Schiff ND. Multimodal neuroimaging approaches to disorders of consciousness. J Head Trauma Rehabil. 2006;21:388–97.PubMedCrossRef
18.
Zurück zum Zitat He BJ, Shulman GL, Snyder AZ, Corbetta M. The role of impaired neuronal communication in neurological disorders. Curr Opin Neurol. 2007;20:655–60.PubMedCrossRef He BJ, Shulman GL, Snyder AZ, Corbetta M. The role of impaired neuronal communication in neurological disorders. Curr Opin Neurol. 2007;20:655–60.PubMedCrossRef
19.
20.
Zurück zum Zitat Raichle ME, Snyder AZ. A default mode of brain function: a brief history of an evolving idea. Neuroimage. 2007;37:1083–90.PubMedCrossRef Raichle ME, Snyder AZ. A default mode of brain function: a brief history of an evolving idea. Neuroimage. 2007;37:1083–90.PubMedCrossRef
21.
Zurück zum Zitat Greicius MD, Krasnow B, Reiss AL, Menon V. Functional connectivity in the resting brain: a network analysis of the default mode hypothesis. Proc Natl Acad Sci USA. 2003;100:253–8.PubMedCentralPubMedCrossRef Greicius MD, Krasnow B, Reiss AL, Menon V. Functional connectivity in the resting brain: a network analysis of the default mode hypothesis. Proc Natl Acad Sci USA. 2003;100:253–8.PubMedCentralPubMedCrossRef
22.
Zurück zum Zitat Fox MD, Corbetta M, Snyder AZ, Vincent JL, Raichle ME. Spontaneous neuronal activity distinguishes human dorsal and ventral attention systems. Proc Natl Acad Sci USA. 2006;103:10046–51.PubMedCentralPubMedCrossRef Fox MD, Corbetta M, Snyder AZ, Vincent JL, Raichle ME. Spontaneous neuronal activity distinguishes human dorsal and ventral attention systems. Proc Natl Acad Sci USA. 2006;103:10046–51.PubMedCentralPubMedCrossRef
23.
Zurück zum Zitat Fernández-Espejo D, Soddu A, Cruse D, et al. A role for the default mode network in the bases of disorders of consciousness. Ann Neurol. 2012;72:335–43.PubMedCrossRef Fernández-Espejo D, Soddu A, Cruse D, et al. A role for the default mode network in the bases of disorders of consciousness. Ann Neurol. 2012;72:335–43.PubMedCrossRef
24.
Zurück zum Zitat Jacobs I, Nadkarni V. The ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation. Circulation. 2004;110:3385–97.PubMedCrossRef Jacobs I, Nadkarni V. The ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes. Update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation. Circulation. 2004;110:3385–97.PubMedCrossRef
25.
Zurück zum Zitat Glover GH, Law CS. Spiral-in/out BOLD fMRI for increased SNR and reduced susceptibility artifacts. Magn Reson Med. 2001;46:515–22.PubMedCrossRef Glover GH, Law CS. Spiral-in/out BOLD fMRI for increased SNR and reduced susceptibility artifacts. Magn Reson Med. 2001;46:515–22.PubMedCrossRef
26.
Zurück zum Zitat Smith SM, Jenkinson M, Woolrich MW, et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage. 2004;23(Suppl 1):S208–19.PubMedCrossRef Smith SM, Jenkinson M, Woolrich MW, et al. Advances in functional and structural MR image analysis and implementation as FSL. Neuroimage. 2004;23(Suppl 1):S208–19.PubMedCrossRef
27.
Zurück zum Zitat Calhoun VD, Liu J, Adali T. A review of group ICA for fMRI data and ICA for joint inference of imaging, genetic, and ERP data. Neuroimage. 2009;45(Suppl 1):S163–72.PubMedCentralPubMedCrossRef Calhoun VD, Liu J, Adali T. A review of group ICA for fMRI data and ICA for joint inference of imaging, genetic, and ERP data. Neuroimage. 2009;45(Suppl 1):S163–72.PubMedCentralPubMedCrossRef
28.
Zurück zum Zitat Beckmann CF, DeLuca M, Devlin JT, Smith SM. Investigations into resting-state connectivity using independent component analysis. Philos Trans R Soc Lond B Biol Sci. 2005;360:1001–13.PubMedCentralPubMedCrossRef Beckmann CF, DeLuca M, Devlin JT, Smith SM. Investigations into resting-state connectivity using independent component analysis. Philos Trans R Soc Lond B Biol Sci. 2005;360:1001–13.PubMedCentralPubMedCrossRef
29.
Zurück zum Zitat Smith SM, Fox PT, Miller KL, et al. Correspondence of the brain’s functional architecture during activation and rest. Proc Natl Acad Sci USA. 2009;106:13040–5.PubMedCentralPubMedCrossRef Smith SM, Fox PT, Miller KL, et al. Correspondence of the brain’s functional architecture during activation and rest. Proc Natl Acad Sci USA. 2009;106:13040–5.PubMedCentralPubMedCrossRef
30.
Zurück zum Zitat Wang X, Foryt P, Ochs R, et al. Abnormalities in resting-state functional connectivity in early human immunodeficiency virus infection. Brain Connect. 2011;1:207–17.PubMedCentralPubMedCrossRef Wang X, Foryt P, Ochs R, et al. Abnormalities in resting-state functional connectivity in early human immunodeficiency virus infection. Brain Connect. 2011;1:207–17.PubMedCentralPubMedCrossRef
31.
Zurück zum Zitat Wijdicks EF, Bamlet WR, Maramatton BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.PubMedCrossRef Wijdicks EF, Bamlet WR, Maramatton BV, Manno EM, McClelland RL. Validation of a new coma scale: the FOUR score. Ann Neurol. 2005;58:585–93.PubMedCrossRef
32.
Zurück zum Zitat Cauda F, Micon BM, Sacco K, et al. Disrupted intrinsic functional connectivity in the vegetative state. J Neurol Neurosurg Psychiatry. 2009;80:429–31.PubMedCrossRef Cauda F, Micon BM, Sacco K, et al. Disrupted intrinsic functional connectivity in the vegetative state. J Neurol Neurosurg Psychiatry. 2009;80:429–31.PubMedCrossRef
33.
Zurück zum Zitat Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, et al. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain. 2010;133:161–71.PubMedCentralPubMedCrossRef Vanhaudenhuyse A, Noirhomme Q, Tshibanda LJ, et al. Default network connectivity reflects the level of consciousness in non-communicative brain-damaged patients. Brain. 2010;133:161–71.PubMedCentralPubMedCrossRef
34.
Zurück zum Zitat Norton L, Hutchison RM, Young GB, Lee DH, Sharpe MD, Mirsattari SM. Disruptions of functional connectivity in the default mode network of comatose patients. Neurology. 2012;78:175–81.PubMedCrossRef Norton L, Hutchison RM, Young GB, Lee DH, Sharpe MD, Mirsattari SM. Disruptions of functional connectivity in the default mode network of comatose patients. Neurology. 2012;78:175–81.PubMedCrossRef
35.
Zurück zum Zitat Rossetti AO, Oddo M, Logroscino G, Kaplan PW. Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol. 2010;67:301–7.PubMed Rossetti AO, Oddo M, Logroscino G, Kaplan PW. Prognostication after cardiac arrest and hypothermia: a prospective study. Ann Neurol. 2010;67:301–7.PubMed
36.
Zurück zum Zitat Fugate JE, Wijdicks EF, White RD, Rabinstein AA. Does therapeutic hypothermia affect time to awakening in cardiac arrest survivors? Neurology. 2011;77:1346–50.PubMedCrossRef Fugate JE, Wijdicks EF, White RD, Rabinstein AA. Does therapeutic hypothermia affect time to awakening in cardiac arrest survivors? Neurology. 2011;77:1346–50.PubMedCrossRef
37.
Zurück zum Zitat Al Thenayan E, Savard M, Sharpe M, Norton L, Young B. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology. 2008;71:1535–7.PubMedCrossRef Al Thenayan E, Savard M, Sharpe M, Norton L, Young B. Predictors of poor neurologic outcome after induced mild hypothermia following cardiac arrest. Neurology. 2008;71:1535–7.PubMedCrossRef
38.
Zurück zum Zitat Mhuircheartaigh RN, Rosenorn-Lanng D, Wise R, Jbabdi S, Rogers R, Tracey I. Cortical and subcortical connectivity changes during decreasing levels of consciousness in humans: a functional magnetic resonance imaging study using propofol. J Neurosci. 2010;30:9095–102.PubMedCrossRef Mhuircheartaigh RN, Rosenorn-Lanng D, Wise R, Jbabdi S, Rogers R, Tracey I. Cortical and subcortical connectivity changes during decreasing levels of consciousness in humans: a functional magnetic resonance imaging study using propofol. J Neurosci. 2010;30:9095–102.PubMedCrossRef
39.
Zurück zum Zitat Boveroux P, Vanhaudenhuyse A, Bruno MA, et al. Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during propofol-induced loss of consciousness. Anesthesiology. 2010;113:1038–53.PubMedCrossRef Boveroux P, Vanhaudenhuyse A, Bruno MA, et al. Breakdown of within- and between-network resting state functional magnetic resonance imaging connectivity during propofol-induced loss of consciousness. Anesthesiology. 2010;113:1038–53.PubMedCrossRef
40.
Zurück zum Zitat Schaafsma A, de Jong BM, Bams JL, Haaxma-Reiche H, Pruim J, Zijlstra JG. Cerebral perfusion and metabolism in resuscitated patients with severe post-hypoxic encephalopathy. J Neurol Sci. 2003;210:23–30.PubMedCrossRef Schaafsma A, de Jong BM, Bams JL, Haaxma-Reiche H, Pruim J, Zijlstra JG. Cerebral perfusion and metabolism in resuscitated patients with severe post-hypoxic encephalopathy. J Neurol Sci. 2003;210:23–30.PubMedCrossRef
Metadaten
Titel
MRI Default Mode Network Connectivity is Associated with Functional Outcome After Cardiopulmonary Arrest
verfasst von
Matthew A. Koenig
John L. Holt
Thomas Ernst
Steven D. Buchthal
Kazuma Nakagawa
Victor A. Stenger
Linda Chang
Publikationsdatum
01.06.2014
Verlag
Springer US
Erschienen in
Neurocritical Care / Ausgabe 3/2014
Print ISSN: 1541-6933
Elektronische ISSN: 1556-0961
DOI
https://doi.org/10.1007/s12028-014-9953-3

Weitere Artikel der Ausgabe 3/2014

Neurocritical Care 3/2014 Zur Ausgabe

Leitlinien kompakt für die Neurologie

Mit medbee Pocketcards sicher entscheiden.

Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag

Update Neurologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.