Use of magnetic resonance imaging in neuroprognostication after pediatric cardiac arrest: Survey of current practices

Background Use of MRI as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric cardiac arrest. METHODS A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support. RESULTS Response rate was 31% (44/143). Thirty-four percent (15/44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22/44) of respondents reported that an MRI is obtained in nearly all CA patients and 32% (14/44) obtain an MRI in those who did not return to baseline neurological status. Sixty-four percent of centers (28/44) obtain an MRI greater than 72 hours after return of spontaneous circulation. Poor neurologic exam was reported as the most common factor (91% [40/44]) determining the timing of the MRI. Conventional sequences (T1, T2, FLAIR, and diffusion weighted imaging/apparent diffusion coefficient) are widely used. Advanced imaging techniques, such as MR spectroscopy, diffusion tensor imaging and resting state functional MRI are less commonly used. CONCLUSIONS Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques, are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.