Feasibility of multi-domain data acquisition in patients at risk for hypoxic-ischemic brain injury following cardiac arrest: a prospective cohort study.

INTRODUCTION

Hypoxic-ischemic brain injury is a determinant of neurologic injury and death among survivors of cardiac arrest. While neurophysiologic and biomarker changes may improve prognostication, the feasibility of acquiring multimodal physiologic, biologic, imaging, and patient-centered outcome data across the continuum of care is not established.

OBJECTIVE

To evaluate the feasibility of (1) patient recruitment; (2) acquiring multi-domain variables; and (3) six-month post-discharge outcomes in a cohort of patients with hypoxic-ischemic brain injury after cardiac arrest.

METHODS

We conducted a feasibility study of adults admitted to a critical care unit following cardiac arrest. In-hospital data collection included serum biomarkers, transcranial Doppler, neuroimaging, and electroencephalography. Post-discharge outcomes were assessed in-person or remotely at 6-months, and included outcome assessments, biomarkers, and MRI brain. Feasibility was defined a priori.

RESULTS

Thirty participants were enrolled (June 2022-May 2023). Biomarker samples were obtained in 29/30 (97%) participants on Day 1, 28/29 (97%) evaluable participants on Day 2, 21/25 (84%) on Day 3, and 12/17 (71%) on Day 7. Transcranial Doppler was completed in 23/30 (77%) participants, limited by inadequate acoustic windows and technical failures. All participants underwent either CT or MRI, and 23/30 (77%) had electroencephalography. Modified Rankin Scale was obtained in 27/30 (90%) participants. At least one six-month follow-up assessment was completed in 9/12 (75%) hospital survivors, while the complete in-person multidomain battery was completed in 4/12 (33%). Follow-up MRI was completed in 1/4 in-person follow-up attendees.

CONCLUSIONS

Early serum biomarker specimen acquisition was feasible, and remote or proxy-assisted approaches increased six-month outcome ascertainment. However, serial transcranial Doppler, later biomarker sampling, systematic MRI acquisition, and full multidomain follow-up were limited by operational and patient-related barriers, particularly the challenges of in-person assessment.