Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

Langkjær, Sandra; Hassager, Christian; Kjærgaard, Jesper; Salam, Idrees; Thomsen, Jakob Hartvig; Lippert, Freddy; Wanscher, Michael; Køber, Lars; Nielsen, Niklas; Søholm, Helle

doi:10.1016/j.resuscitation.2015.03.023

Cited by 24 publications

(10 citation statements)

References 28 publications

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“…89 In contrast, a Swedish group documented that reduced discrimination between white and grey matter on an early CT scan was strongly associated with a poor outcome; however only 7 (4%) of 188 patients scanned within 24 h of cardiac arrest showed reduced grey-white discrimination. 90 Using the data from 19 post-cardiac arrest patients who underwent brain MRI scanning, a group from Korea has developed a qualitative MRI scoring system to assess the severity of hypoxic-ischaemic brain injury. 91 Another group have studied 22 post-cardiac arrest patients who underwent repeat MRI scanningthey hypothesise that the evolving changes seen on MRI may better predict outcome.…”

Section: Prognosticationmentioning

confidence: 99%

Resuscitation highlights in 2015

et al. 2016

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Section: Prognosticationmentioning

confidence: 99%

Resuscitation highlights in 2015

et al. 2016

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“…In particular, neurological outcomes have been investigated more in patients with stable vital signs and reversible causes of arrest after a return of spontaneous circulation (ROSC). In the setting of conventional cardiopulmonary resuscitation (CPR), several predictors of neurological outcome have been reported such as physical examination of brainstem reflexes, various serum markers, and electrophysiologic study results [2–4]. Additionally, brain imaging may be helpful for predicting neurological outcomes after cardiac arrest [5–11].…”

Section: Introductionmentioning

confidence: 99%

The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation

et al. 2017

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BackgroundLimited data are available on imaging predictors of neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR). We investigated the association of initial brain computed tomography (CT) findings with neurological outcomes following ECPR.MethodsBetween February 2005 and December 2015, a total of 42 patients who underwent brain CT scans within 48 h after ECPR were analyzed. Loss of the boundary between gray matter and white matter (LOB) or cortical sulcal effacement (SE), gray-to-white matter ratio (GWR), and optic nerve sheath diameter (ONSD) were measured on initial brain CT. The primary outcome was the Cerebral Performance Categories (CPC) scale at discharge.ResultsOf the 42 adult ECPR patients, 23 (54.8%) patients survived to discharge and 19 (45.2%) patients had good neurological outcomes (CPC 1 and 2). The area under the curve (AUC) of GWR in the basal ganglia (GWR-BG) was 0.792 (95% confidence interval (CI), 0.639–0.901, p = 0.001). ONSD (AUC 0.745; 95% CI, 0.587 – 0.867, p = 0.007) was 5.57 (interquartile range (IQR) 5.14 – 5.98) mm in the good neurological outcome group versus 6.07 (IQR 5.71 – 6.64) mm in the poor outcome group. LOB or SE were more often detected in the poor neurological outcome group (AUC 0.817; 95% CI, 0.682–0.952, p <0.001). The predictive performance of poor neurological outcomes of a composite of GWR-BG, ONSD, and LOB/SE was significantly improved (AUC 0.904; 95% CI, 0.773–0.973) compared to when each brain CT marker was considered separately (GWR-BG, p = 0.048; ONSD, p = 0.026; LOB/SE, p = 0.028).ConclusionsGWR, ONSD, and LOB/SE on initial brain CT scans are associated with neurological prognosis in patients who underwent ECPR. The new risk prediction model, which uses a composite of GWR, ONCD, and LOB/SE, could provide better information on neurologic outcomes in patients underwent ECPR.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1604-6) contains supplementary material, which is available to authorized users.

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“…We previously demonstrated that the HERS is associated with a decreased mortality in patients with severe blunt trauma compared to that with conventional trauma management, after accounting for potential confounders (adjusted odds ratio [OR], 0.50; 95% confidence interval [CI], 0.29-0.85; p = 0.011) [4]. Patients treated with the HERS had shorter time intervals from ER arrival to CT examination and emergency surgery compared to those for conventional management (median [25th-75th percentiles]: 11 [8][9][10][11][12][13][14][15][16] [4]. These beneficial observations contributed to the rapid spread of the HERS concept; as of September 2019, eleven tertiary emergency hospitals in Japan and one trauma center in Korea have installed a HERS.…”

mentioning

confidence: 99%

“…If an acute ischemic stroke/intracranial hemorrhage is suspected as a precipitant, head CT should be performed for further interventions. Immediate brain CT after ROSC in patients treated with therapeutic hypothermia can help predict the outcome [11,12].…”

mentioning

confidence: 99%

Potential impacts of a novel integrated extracorporeal-CPR workflow using an interventional radiology and immediate whole-body computed tomography system in the emergency department

Hayashida

Kinoshita

Miyara

et al. 2020

BMC Cardiovasc Disord

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Extracorporeal cardiopulmonary resuscitation (ECPR) can be associated with increased survival and neurologic benefits in selected patients with out-of-hospital cardiac arrest (OHCA). However, there remains insufficient evidence to recommend the routine use of ECPR for patients with OHCA. A novel integrated trauma workflow concept that utilizes a sliding computed tomography (CT) scanner and interventional radiology (IR) system, named a hybrid emergency room system (HERS), allowing emergency therapeutic interventions and CT examination without relocating trauma patients, has recently evolved in Japan. HERS can drastically shorten the ECPR implementation time and more quickly facilitate definitive interventions than the conventional advanced cardiovascular life support workflow. Herein, we discuss our novel workflow concept using HERS on ECPR for patients with OHCA.

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Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

Cited by 24 publications

References 28 publications

Resuscitation highlights in 2015

Resuscitation highlights in 2015

The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation

Potential impacts of a novel integrated extracorporeal-CPR workflow using an interventional radiology and immediate whole-body computed tomography system in the emergency department

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