Outcome prediction with resting-state functional connectivity after cardiac arrest

Sci Rep. 2020 Jul 16;10(1):11695. doi: 10.1038/s41598-020-68683-y.

Abstract

Predicting outcome in comatose patients after successful cardiopulmonary resuscitation is challenging. Our primary aim was to assess the potential contribution of resting-state-functional magnetic resonance imaging (RS-fMRI) in predicting neurological outcome. RS-fMRI was used to evaluate functional and effective connectivity within the default mode network in a cohort of 90 comatose patients and their impact on functional neurological outcome after 3 months. The RS-fMRI processing protocol comprises the evaluation of functional and effective connectivity within the default mode network. Seed-to-voxel and ROI-to-ROI feature analysis was performed as starting point for a supervised machine-learning approach. Classification of the Cerebral Performance Category (CPC) 1-3 (good to acceptable outcome) versus CPC 4-5 (adverse outcome) achieved a positive predictive value of 91.7%, sensitivity of 90.2%, and accuracy of 87.8%. A direct link to the level of consciousness and outcome after 3 months was identified for measures of segregation in the precuneus, in medial and right frontal regions. Thalamic connectivity appeared significantly reduced in patients without conscious response. Decreased within-network connectivity in the default mode network and within cortico-thalamic circuits correlated with clinical outcome after 3 months. Our results indicate a potential role of these markers for decision-making in comatose patients early after cardiac arrest.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Brain Mapping / methods*
  • Cardiopulmonary Resuscitation
  • Clinical Decision-Making
  • Coma / diagnostic imaging*
  • Coma / etiology
  • Consciousness
  • Female
  • Heart Arrest / complications
  • Heart Arrest / diagnostic imaging*
  • Humans
  • Machine Learning*
  • Magnetic Resonance Imaging / methods*
  • Male
  • Middle Aged
  • Nerve Net / diagnostic imaging
  • Nerve Net / physiopathology
  • Neural Pathways / diagnostic imaging
  • Neural Pathways / physiopathology
  • Prognosis
  • Prospective Studies
  • Thalamus / diagnostic imaging
  • Thalamus / physiopathology
  • Young Adult