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.
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Acknowledgments
The authors thank Denise Dittrich, RN and Tracy Stern, RN from the Queen’s Medical Center Neuroscience Institute for study coordination; Todd Seto, MD from the Queen’s Medical Center Department of Cardiology for assistance with database design; and Ahnate Lim from the University of Hawaii MRI Research Center for assistance with data processing. Funding support for this study was provided by the Hawaii Community Foundation Grant 11ADVC-49231, Queen Emma Research Fund, and NIH Grants 1P30GM103341-01, U54NS56883, and K24DA16170.
Conflict of interest
Matthew Koenig declares that he has no conflict of interest. John Holt declares that he has no conflict of interest. Thomas Ernst consults for and holds patents through Kineticor, Inc. Steven Buchthal declares that he has no conflict of interest. Kazuma Nakagawa declares that he has no conflict of interest. Victor Stenger declares that he has no conflict of interest. Linda Chang declares that she has no conflict of interest.
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Koenig, M.A., Holt, J.L., Ernst, T. et al. MRI Default Mode Network Connectivity is Associated with Functional Outcome After Cardiopulmonary Arrest. Neurocrit Care 20, 348–357 (2014). https://doi.org/10.1007/s12028-014-9953-3
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DOI: https://doi.org/10.1007/s12028-014-9953-3