Publications by authors named "Marion Moseby-Knappe"
Background: In Europe, approximately 291,000 cardiac arrests occur annually. Despite critical care therapy, hospital mortality remains high. This systematic review assessed whether, in comatose survivors of cardiac arrest, any drug therapy, compared to placebo or usual care, improves outcomes.
View Article and Find Full Text PDFMagnetic resonance imaging in comatose adults resuscitated after out-of-hospital cardiac arrest: A posthoc study of the Targeted Therapeutic Mild Hypercapnia after Resuscitated Cardiac Arrest trial.
Aust Crit Care
November 2024
Article Synopsis
- Neuroimaging using MRI can help assess brain injuries in comatose adults after cardiac arrest, but data on its use is limited.
- In a study involving 1,639 patients from the TAME trial, only 9% underwent MRI, showing key differences in age, time to resuscitation, and lactate levels compared to those who did not.
- Six months later, only 16% of MRI patients had a favorable neurological outcome, highlighting concerns about the effectiveness of MRI in this context.
Article Synopsis
- The study aimed to use standardized and automated CT assessments to predict outcomes for patients who suffered out-of-hospital cardiac arrest.
- Involving 140 unconscious patients, results showed that while qualitative assessments and various gray-white-matter ratio (GWR) models achieved 100% specificity in predicting poor outcomes, sensitivity rates varied, with automated GWR proving robust.
- The research concluded that these CT assessment methods could reliably indicate poor functional outcomes, and automated GWR could enhance accessibility for medical centers handling cardiac arrest cases.
Background: To assess whether retrograde cerebral perfusion reduces neurological injury and mortality in patients undergoing surgery for acute type A aortic dissection.
Methods: Single-center, retrospective, observational study including all patients undergoing acute type A aortic dissection repair with deep hypothermic circulatory arrest between January 1998 and December 2022 with or without the adjunct of retrograde cerebral perfusion. 515 patients were included: 257 patients with hypothermic circulatory arrest only and 258 patients with hypothermic circulatory arrest and retrograde cerebral perfusion.
Article Synopsis
- Selective water uptake by brain cells and brain tissue swelling after cardiac arrest contribute to hypoxic-ischemic encephalopathy, with CT scans used to evaluate this condition over time.
- This study included head CT scans from 115 cardiac arrest patients to analyze regional net water uptake (NWU) and its relationship with neurological outcomes.
- Results showed that a significant NWU (>8%) in certain brain regions was linked to poor neurological outcomes, suggesting that NWU could be a valuable biomarker for patient prognosis after cardiac arrest.
Article Synopsis
- - The study aimed to assess the effectiveness of glial fibrillary acidic protein (GFAP) and total-tau in predicting neurological outcomes in patients who suffered cardiac arrest, comparing these biomarkers with neurofilament light (NFL) and neuron-specific enolase (NSE).
- - Conducted in three Swedish hospitals between 2014 and 2018, researchers examined blood samples from 428 cardiac arrest patients at various times post-arrest, finding that GFAP was a strong predictor of poor neurological outcomes at multiple time points.
- - Results indicated that while GFAP and tau show promise as biomarkers, NFL demonstrated equal or superior predictive capabilities compared to GFAP and tau after both out-of-hospital and in-hospital cardiac arrests. Additionally
Article Synopsis
- The study evaluated the effectiveness of highly malignant EEG patterns (HMEP) in predicting poor neurological outcomes after cardiac arrest, following 2021 guidelines from the ERC and ESICM.
- In a multicenter trial involving 845 patients, HMEP showed 50% sensitivity and 93% specificity for poor outcomes, with an increase in specificity to 97% when combined with an unresponsive EEG.
- The findings indicate that while the specificity of these EEG patterns is high, it's less than previously reported, suggesting a need for cautious application in clinical settings due to potential biases affecting results.
Article Synopsis
- The study investigates the effectiveness of the 2021 ERC/ESICM neuroprognostication algorithm, expanding the entry criteria to include unconscious patients with Glasgow Coma Scale-Motor (GCS-M) scores of 4-5 and those under sedation.
- Conducted as a retrospective observational study across four ICUs in Sweden, it analyzed outcomes for postcardiac arrest patients treated between 2014 and 2018.
- Results showed that modifying the algorithm allowed for the identification of additional patients with poor outcomes, with a consistent false positive rate of 0% across various criteria assessments.
Objective: The study objective was to assess the radiological properties of acute type A aortic dissection-related neurological injuries and identify predictors of neurological injury.
Methods: Our single-center, retrospective, observational study included all patients who underwent acute type A aortic dissection repair between January 1998 and December 2021. Multivariable analyses and Cox regression were performed to identify predictors of embolic lesions, watershed lesions, neurological injury, 30-day mortality, and late mortality.
Article Synopsis
- The TTM2 trial found no significant difference in mortality or poor functional outcomes between targeted hypothermia and targeted normothermia 6 months after out-of-hospital cardiac arrest (OHCA).
- A detailed analysis aimed to assess brain dysfunction and cognitive function in survivors, focusing on societal participation after OHCA.
- This study involved 1861 comatose adults across 61 hospitals in 14 countries, with follow-up conducted by masked assessors showing no differences in functional outcomes between the two temperature control methods.
Article Synopsis
- The study aims to investigate serum proteome profiles of unconscious patients after out-of-hospital cardiac arrest to understand the biological effects of hypoxia-ischaemia and temperature management on neurological outcomes.
- Researchers analyzed serum samples at 24, 48, and 72 hours post-cardiac arrest using mass spectrometry to identify protein changes linked to patient outcomes at a six-month follow-up.
- Results showed that out of 78 patients, many had poor neurological outcomes, with specific proteins associated with either poor or good recovery, indicating potential paths for further research and therapy development.
Introduction: Neurological complications after surgery for acute type A aortic dissection (ATAAD) increase patient morbidity and mortality. Carbon dioxide flooding is commonly used in open-heart surgery to reduce the risk of air embolism and neurological impairment, but it has not been evaluated in the setting of ATAAD surgery. This report describes the objectives and design of the CARTA trial, investigating whether carbon dioxide flooding reduces neurological injury following surgery for ATAAD.
View Article and Find Full Text PDFBackground: This study investigated the association of two levels of targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA) with administered doses of sedative and analgesic drugs, serum concentrations, and the effect on time to awakening.
Methods: This substudy of the TTM2-trial was conducted at three centers in Sweden, with patients randomized to either hypothermia or normothermia. Deep sedation was mandatory during the 40-hour intervention.
Article Synopsis
- The study investigates if blood levels of phosphorylated tau (p-tau) and amyloid-β peptides (Aβ) can serve as biomarkers for predicting neurological outcomes in patients who have experienced cardiac arrest.
- Researchers conducted a clinical biobank study involving 717 unconscious cardiac arrest patients, comparing blood biomarker levels taken at different times after the event with neural injury markers.
- Results from this study could help distinguish between patients with good and poor neurological outcomes, potentially aiding in more effective prognostication after cardiac arrest.
Article Synopsis
- This study investigates the effectiveness of neurofilament light (NfL) levels in predicting long-term outcomes in patients after out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA) within the first 48 hours.* -
- Results showed that 68% of OHCA patients and 55% of IHCA patients experienced poor outcomes, with NfL exhibiting high prognostic accuracy at 12 and 48 hours post-OHCA (AUROC of 0.93 and 0.97), but lower accuracy for IHCA (AUROC of 0.81 and 0.86).* -
- The findings suggest NfL levels can reliably indicate outcomes as early
Background: Neurological injuries are frequent following Acute Type A Aortic Dissection (ATAAD) repair occurring in 4-30% of all patients. Our objective was to study whether S100B can predict neurological injury following ATAAD repair.
Methods: This was a single-center, retrospective, observational study.
Background/aim: Signs of hypoxic ischaemic encephalopathy (HIE) on head computed tomography (CT) predicts poor neurological outcome after cardiac arrest. We explore whether levels of brain injury markers in blood could predict the likelihood of HIE on CT.
Methods: Retrospective analysis of CT performed at 24-168 h post cardiac arrest on clinical indication within the Target Temperature Management after out-of-hospital cardiac arrest-trial.
Article Synopsis
- Head CT is a recommended method for predicting outcomes after cardiac arrest, but there is no standardized assessment system for diagnosing hypoxic-ischaemic encephalopathy (HIE).
- The study is part of an international trial (TTM2) aiming to evaluate CT images of patients who are still unconscious 48 hours after cardiac arrest, using a standardized protocol to assess HIE severity and related brain function.
- The outcomes will be measured through functional assessments at six months post-arrest, and findings will help establish reliable criteria for using CT in neuroprognostication after cardiac arrest.
Article Synopsis
- In Sweden, a study evaluated the effectiveness of routine and novel CT methods for predicting neurological outcomes after cardiac arrest, focusing on their prognostic ability and interrater variability.
- The research included a retrospective analysis of patients, assessing CT images using both qualitative (eye-balling) and quantitative (grey-white matter ratios) techniques to determine the likelihood of poor outcomes over different time frames.
- Results showed that while early CT assessments had high specificity but low sensitivity, those conducted after 24 hours significantly improved sensitivity, highlighting the need for standardized evaluation methods due to interrater variability issues.
Article Synopsis
- Scientists are studying blood markers that can help doctors understand how serious a brain injury is after someone has a cardiac arrest (when the heart stops).
- They are doing tests to find out which blood marker is the best at predicting how well a person will recover after six months.
- The goal is to set clear rules for doctors to follow so they can use these markers in everyday medical care to help patients better.
Article Synopsis
- EEG is used to predict neurological outcomes after cardiac arrest and this study examined its relationship with neurofilament light (NfL) as a marker of brain injury.
- The analysis included 262 patients and found that those with highly malignant EEG patterns had significantly higher NfL levels compared to those with less severe EEG patterns.
- The study concluded that EEG background was more strongly associated with NfL levels than the number of EEG discharges, indicating that the type of EEG background could reflect the severity of neuronal injury.
Objective: To explore associations between four methods assessing long-term neurocognitive outcome after out-of-hospital cardiac arrest and early hypoxic-ischemic neuronal brain injury assessed by the biomarker serum neurofilament light (NFL), and to compare the agreement for the outcome methods.
Methods: An explorative post-hoc study was conducted on survivor data from the international Target Temperature Management after Out-of-hospital Cardiac Arrest trial, investigating serum NFL sampled 48/72-hours post-arrest and neurocognitive outcome 6 months post-arrest.
Results: Among the long-term surviving participants ( = 457), serum NFL ( = 384) was associated to all outcome instruments, also when controlling for demographic and cardiovascular risk factors.
Purpose: The majority of unconscious patients after cardiac arrest (CA) do not fulfill guideline criteria for a likely poor outcome, their prognosis is considered "indeterminate". We compared brain injury markers in blood for prediction of good outcome and for identifying false positive predictions of poor outcome as recommended by guidelines.
Methods: Retrospective analysis of prospectively collected serum samples at 24, 48 and 72 h post arrest within the Target Temperature Management after out-of-hospital cardiac arrest (TTM)-trial.