ArticleJournal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia2026
Spinal cord ischemia following pediatric cardiac arrest: An unexplored complication of hypoxic ischemic injury.
Article in Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHypoxic-ischemic brain injury (HIBI) is a well-described sequela of pediatric cardiac arrest, but the epidemiology and clinical implications of hypoxic-ischemic spinal cord injury (HISCI) remain poorly understood. Only isolated reports describe HISCI following cardiopulmonary resuscitation (CPR). We aimed to describe the incidence, imaging characteristics, and clinical context of HISCI inpediatriccardiac arrest patients undergoing clinically indicated MRI.
methodsWe conducted a single-center retrospective descriptive case series of consecutively identified pediatric cardiac arrest patients who underwent spinal magnetic resonance imaging (MRI) within two weeks of resuscitation (2018-2023). Cases were identified from an institutional cardiac arrest database. MRI scans were independently reviewed by a pediatric neuroradiologist for evidence of HISCI.
resultsOf 717 cardiac arrest patients, 36 (5%) underwent spinal MRI within two weeks of arrest, primarily for trauma evaluation (72%). Four patients (11%) had MRI evidence of HISCI. All four experienced out-of-hospital cardiac arrest with CPR durations ranging from 8 to 90 min and initial serum lactate > 4 mmol/L. Two arrests were traumatic. All four patients had concomitant HIBI, and two met criteria for death by neurologic criteria. Among the 32 patients without HISCI, 9 (28%) had HIBI and 19 (59%) had traumatic arrest.
conclusionsHISCI was identified in 11% of pediatric cardiac arrest patients who underwent post-arrest spinal MRI for clinical indications. Recognition of HISCI has potential implications for neuroprognostication, rehabilitation planning, and determination of brain death by neurologic criteria. Larger prospective studies are needed to define the incidence, risk factors, and outcomes of HISCI following pediatric cardiac arrest.
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