Grey–white matter ratio measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest

Hong, Jun Young; Lee, Dong Hoon; Oh, Je Hyeok; Lee, Sun Hwa; Choi, Yoon Hee; Kim, Soo Hyun; Min, Jin Hong; Kim, Su Jin; Park, Yoo Seok

doi:10.1016/j.resuscitation.2019.03.039

Cited by 45 publications

(32 citation statements)

References 24 publications

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“…The 2015 American Heart Association recommends using GWR in CT to predict poor neurologic outcomes [2]. However, a recent prospective multi-center study of 512 patients reported that the GWR assessed via early brain CT alone was not an independent factor predictive of poor neurologic outcomes [14]. Thus, they suggested that brain CT scans performed during the first 2 h after ROSC may not allow sufficient time for the formation of cerebral edema and increased intracranial pressure.…”

Section: Discussionmentioning

confidence: 99%

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

JCM

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We examined whether combining biomarkers measurements and brain images early after the return of spontaneous circulation improves prognostic performance compared with the use of either biomarkers or brain images for patients with cardiac arrest following target temperature management (TTM). This retrospective observational study involved comatose out-of-hospital cardiac arrest survivors. We analyzed neuron-specific enolase levels in serum (NSE) or cerebrospinal fluid (CSF), grey-to-white matter ratio by brain computed tomography, presence of high signal intensity (HSI) in diffusion-weighted imaging (DWI), and voxel-based apparent diffusion coefficient (ADC). Of the 58 patients, 33 (56.9%) had poor neurologic outcomes. CSF NSE levels showed better prognostic performance (area under the curve (AUC) 0.873, 95% confidence interval (CI) 0.749–0.950) than serum NSE levels (AUC 0.792, 95% CI 0.644–0.888). HSI in DWI showed the best prognostic performance (AUC 0.833, 95% CI 0.711–0.919). Combining CSF NSE levels and HSI in DWI had better prognostic performance (AUC 0.925, 95% CI 0.813–0.981) than each individual method, followed by the combination of serum NSE levels and HSI on DWI and that of CSF NSE levels and the percentage of voxels of ADC (AUC 0.901, 95% CI 0.792–0.965; AUC 0.849, 95% CI 0.717–0.935, respectively). Combining CSF/serum NSE levels and HSI in DWI before TTM improved the prognostic performance compared to either each individual method or other combinations.

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Section: Discussionmentioning

confidence: 99%

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Son

Park

Yoo

et al. 2020

JCM

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“…Evaluation of corneal reflexes affords a rapid bedside assessment of brainstem reflexes that may afford prognostic value. Bilateral absence of corneal reflexes immediately after return of spontaneous circulation has been found to be associated with worse survival and neurologic outcomes 27,28 . However, in these studies corneal reflexes were absent immediately after return of spontaneous circulation in 68% of survivors 27 and 25% of survivors with a good outcome, 28 indicating an unacceptably high false‐positive rate for predicting a poor neurologic outcome.…”

Section: Clinical Examinationmentioning

confidence: 85%

“…Often, a CT scan is ordered to assess for injuries related to trauma from a fall after an arrest or to assess for alternative etiologies of arrest such as spontaneous intracranial hemorrhage. A more recent prospective, multi‐center study evaluated 512 patients receiving CT within 2 hours of return of spontaneous circulation after out‐of‐hospital cardiac arrest and found no correlation between gray–white matter ratio and neurologic outcome at 6 months 28 . Given the higher quality of this recent prospective study, the validity of earlier retrospective CT studies and meta‐analysis must be brought into question.…”

Section: Imaging Studiesmentioning

confidence: 97%

“…Absent qualitative pupillary light reflex from bedside examination has also been studied as an indicator of a poor prognosis. However, the qualitative absence of pupillary light reflexes has been reported to have false–positive rate of 63%, 27 47.5%, 29 30%, 26 and 15% 28 when performed in the ED. Even at 24 hours, there are patients with qualitatively absent pupillary reflexes that have gone on to have good neurologic outcomes 30 …”

Section: Clinical Examinationmentioning

confidence: 99%

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Neurologic prognostication after resuscitation from cardiac arrest

2020

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Out‐of‐hospital cardiac arrest remains a leading cause of mortality in the United States, and the majority of patients who die after achieving return of spontaneous circulation die from withdrawal of care due to a perceived poor neurologic prognosis. Unfortunately, withdrawal of care often occurs during the first day of admission and research suggests this early withdrawal of care may be premature and result in unnecessary deaths for patients who would have made a full neurologic recovery. In this review, we explore the evidence for neurologic prognostication in the emergency department for patients who achieve return of spontaneous circulation after an out‐of‐hospital cardiac arrest.

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“…However, brain CT performed at an early stage (especially within 2 hr) has the disadvantage of a low sensitivity [ 20 – 22 ]. When brain CT is repeated, the predictive value increases [ 32 ]. Therefore, when discussing the predictive power of brain CT for outcome prediction after CA, the scan time is a very important issue.…”

Section: Discussionmentioning

confidence: 99%

Neuron-specific enolase and neuroimaging for prognostication after cardiac arrest treated with targeted temperature management

Kim

Park

et al. 2020

PLoS ONE

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Background Prognostication after cardiac arrest (CA) needs a multimodal approach, but the optimal method is not known. We tested the hypothesis that the combination of neuron-specific enolase (NSE) and neuroimaging could improve outcome prediction after CA treated with targeted temperature management (TTM). Methods A retrospective observational cohort study was performed on patients who underwent at least one NSE measurement between 48 and 72 hr; received both a brain computed tomography (CT) scan within 24 hr and diffusion-weighted magnetic resonance imaging (DW-MRI) within 7 days after return of spontaneous circulation (ROSC); and were treated with TTM after out-of-hospital CA between 2009 and 2017 at the Seoul St. Mary's Hospital in Korea. The primary outcome was a poor neurological outcome at 6 months after CA, defined as a cerebral performance category of 3-5. Results A total of 109 subjects underwent all three tests and were ultimately included in this study. Thirty-four subjects (31.2%) experienced good neurological outcomes at 6 months after CA. The gray matter to white matter attenuation ratio (GWR) was weakly correlated with the mean apparent diffusion coefficient (ADC), PV400 and NSE (Spearman's rho: 0.359,-0.362 and-0.263, respectively). NSE was strongly correlated with the mean ADC and PV400 (Spearman's rho:-0.623 and 0.666, respectively). Serum NSE had the highest predictive value among the single parameters (area under the curve (AUC) 0.912, sensitivity 70.7% for maintaining 100% specificity). The combination of a DWI parameter (mean ADC or PV400)

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Grey–white matter ratio measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest

Cited by 45 publications

References 24 publications

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Does Combining Biomarkers and Brain Images Provide Improved Prognostic Predictive Performance for Out-Of-Hospital Cardiac Arrest Survivors before Target Temperature Management?

Neurologic prognostication after resuscitation from cardiac arrest

Neuron-specific enolase and neuroimaging for prognostication after cardiac arrest treated with targeted temperature management

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