MOCA Imaging

MOCA Imaging: Multimodal network connectivity architecture of the brain and its role in the recovery of consciousness in comatose cardiac arrest patients

Supported by: NIH/National Institute of Neurological Disorders and Stroke (NINDS)

Principal Investigator at BMC: David Greer, MD

Primary Research Contact: Veronica Romines, BS (617-638-5492)

Summary

Cardiovascular disease remains the leading cause of death in the United States. A large subset of patients initially comatose after cardiac arrest will have normal neuroimaging and electrophysiology, only to deteriorate in the subsequent days. This likely represents a therapeutic window prior to the onset progressive ischemia, apoptosis, hypoperfusion and cerebral edema, which most often leads to poor outcome. We hypothesize that multimodal approaches that include clinical, electrophysiology, biochemical and MRI data will improve prognostication of short-term and long-term outcome in initially comatose cardiac arrest patients, helping to identify those most likely to benefit from therapeutic interventions in the future.

The primary goal is to understand and quantify which changes in the brain after cardiac arrest, including electrophysiological, neuroimaging and clinical factors, presage poor outcome as steps towards tailoring interventions to prevent neurologic deterioration and identifying patients who might benefit from such therapies.

Enrollment Criteria

Inclusion Criteria:

To be eligible to participate in this study, an individual must meet all of the following criteria:

1. Age ≥18
2. Clinical diagnosis of coma secondary to cardiac arrest
3. Glasgow Coma Scale ≤8 at 24 hours post-ROSC if not TTM-treated, or 24 hours post-rewarming (37°C) if TTM-treated
4. No known previous history of dementia
5. Out-of-hospital cardiac arrest (OHCA), defined as experiencing a cardiac arrest while not an inpatient at the enrolling hospital
6. Legally authorized representative is available to provide written informed consent if patient is unable to provide consent

Exclusion Criteria:

An individual who meets any of the following criteria will be excluded form participation in this study:

1. Not able to tolerate or safely undergo MRI before discharge
2. Any contraindication for MRI, e.g. presence of a pacemaker, ferromagnetic aneurysm clip, etc.
3. Women known to be pregnant, lactating or having a positive or indeterminate pregnancy test
4. Rapid awakening and following commands post-return of spontaneous circulation
5. Brain death
6. Pre-cardiac arrest condition that carries a poor likelihood of survival at 1 year (e.g. terminal cancer)
7. Written living will that excludes the patient from life-sustaining treatment
8. Made “comfort measures only” prior to enrollment
9. Any contraindication for MRI, e.g. presence of a pacemaker, ferromagnetic aneurysm clip, etc. pre-menopausal women with a positive pregnancy blood test, or severe claustrophobia
10. Known history of dementia
11. Likely to have a CPC score to 2 or greater based on a pre-arrest condition

Status: Actively enrolling patients