Hypoxic-ischemic spinal cord injury following resuscitated cardiac arrest: a case series and rapid literature review

Abstract

Purpose: Cardiac arrest can cause hypoxic-ischemic injury and result in both spinal cord injury and death determination by neurologic criteria (DNC). The presence and severity of hypoxic-ischemic spinal cord injury (HISCI) impacts neuro-prognostication, rehabilitation, and may confound DNC evaluation in patients by interfering with motor responses and respiratory muscle function in apnea testing. We describe five children with postarrest HISCI detected on magnetic resonance imaging (MRI) and supplement our observations with a literature review. Clinical features: Postarrest HISCI was identified in five consecutive pediatric cases of prolonged cardiac arrest and hypoxic-ischemic brain injury in a single centre. All patients had cardiopulmonary resuscitation for > 30 min and resultant severe hypoxic-ischemic brain injury. Spinal MRI indications were loss of rectal tone (n = 3), focal deficit (n = 1), and practice change related to recent cases (n = 1). A rapid review of the literature yielded case reports, case series, and retrospective reviews describing 90 patients (81 adults; nine pediatric) with postarrest HISCI. Ischemia distribution was variable, most frequently reported at the cervical and thoracic levels, although some patients had ischemia of the entire cord. Paraplegia was the most common deficit among survivors. There were no reports of HISCI in patients who underwent assessment for DNC. Conclusions: This case series and rapid literature review highlights that both adults and children may be at risk of HISCI after prolonged cardiac arrest. Our findings suggest that further research should focus on determining the incidence and sequelae of HISCI after resuscitated cardiac arrest, as well as evaluating its potential impact on DNC practice and neuro-prognostication.