Observational studyCritical care (London, England)2025
The semi-quantitative cardiac arrest brain ischemia (CABI) score for magnetic resonance imaging predicts functional outcome after cardiac arrest.
Observational study in Critical care (London, England), 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04974775 (Swecrit Biobank - Blood Samples From Critically Ill Patients and Healthy Controls), which is not on this map. Not yet cited in PubMed.
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Swecrit Biobank - Blood Samples From Critically Ill Patients and Healthy Controls
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Abstract
backgroundMagnetic resonance imaging (MRI) is recommended by guidelines to evaluate the severity of brain ischemia after cardiac arrest for functional outcome prediction. However, standardized assessment criteria are lacking. We have developed a semi-quantitative Cardiac Arrest Brain Ischemia (CABI) score to assess the extension of brain ischemia on MRI.
objectivesTo evaluate the prognostic performance of a novel semi-quantitative CABI score in comparison to qualitative routine radiological MRI assessment after cardiac arrest.
methodsA retrospective, multicenter observational study of adults (≥ 18 years-old) admitted to intensive care after cardiac arrest at four Swedish hospitals from 2014 to 2018. Four radiologists, blinded to clinical information except patient age, assessed the MRI as per guideline recommendations and according to the CABI score. The CABI score evaluates extension of ischemia in 12 predefined territories (3 cortical and 2 deep grey nuclei territories bilaterally based on vascular supply; the cerebellum; and the brainstem) from 0-3 (0 = No acute ischemic lesion; 3 ≥ 50% of the territory). The CABI score ranges from 0-36. Poor functional outcome was defined as Cerebral Performance Category 3-5 assessed at 2-6 months post-arrest. Prognostic ability was evaluated with sensitivity and specificity and with the area under the receiver operating characteristics curve (AUC). Inter-rater reliability was calculated by Fleiss´ Kappa or intraclass correlation coefficient.
resultsNinety (n = 90) patients examined with MRI at median 5 days (IQR: 3.7-6.3) were included Median age was 63.7 years (IQR: 58.3-70.5), 74.4% (n = 67) were men and 85.6% (n = 77) had a poor functional outcome. Among four blinded raters, routine qualitative assessment according to guidelines showed 84.6-100% specificity and 61-76.6% sensitivity for poor outcome. Inter-rater reliability for the qualitative assessment was moderate (Fleiss κ = 0.64, 95% CI: 0.53-0.75). The CABI score achieved an AUC of 0.87-0.92 (p< 0.05 vs. routine assessment) and a sensitivity of 59.7-85.7% while maintaining high specificity (76.9-100%) at cut-off ≥ 8 points. The intraclass correlation coefficient (ICC) for the CABI score was 0.67 (95% CI: 0.58-0.75), reflecting moderate agreement among raters.
conclusionA semi-quantitative approach to MRI evaluations after cardiac arrest may increase the prognostic accuracy compared to non-standardized routine assessment.
trial registrationSweCrit biobank, retrospectively registered at ClinicalTrials.gov no. NCT04974775 18th of June 2021.
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