Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest

Chang, Jason J.; Tsivgoulis, Georgios; Goyal, Nitin; Alsherbini, Khalid; Schuring, Craig; Shrestha, Ramesh; Yankovich, Andrei; Metter, Jeffrey; Sareen, Srishti; Elijovich, Lucas; Malkoff, Marc; Murillo, Luis C.; Kadaria, Dipen; Alexandrov, Andrei V.; Sodhi, Amik

doi:10.1016/j.jns.2019.116437

Cited by 4 publications

(2 citation statements)

References 36 publications

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“…122 On the other hand, a scoring system based on parameters such as gray-white matter effacement prior to TTM showed a significant relationship with the discharge destination, mortality and neurologic outcome. 123 Of note, the interpretation of early post-CA CT scans by emergency physicians and radiologists showed acceptable inter-rater reliability (Kappa statistics: 0.66). 124 In contrast, another study showed that interobserver variability when identifying ischemic brain injury was moderate to high (kappa statistics: 0.0-0.48) on head CT scans obtained from adults within two hours of resuscitation from out-of-hospital cardiac arrest.…”

Section: Neuroimagingmentioning

confidence: 92%

“…125 In addition, using specialized scoring systems, extensive anoxic brain injury revealed by early CT (performed before the initiation of TTM) was associated with unfavorable outcome. 123,126 Despite the lack of uniformly recognized quantitative interpretation methodology, brain CT performed at least 24 hours after ROSC might be better if an evaluation of cerebral edema is required for early neuro-prognostication.…”

Section: Neuroimagingmentioning

confidence: 99%

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Targeted temperature management and early neuro-prognostication after cardiac arrest

Chen

Lachance

Gao

et al. 2021

J Cereb Blood Flow Metab

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Targeted temperature management (TTM) is a recommended neuroprotective intervention for coma after out-of-hospital cardiac arrest (OHCA). However, controversies exist concerning the proper implementation and overall efficacy of post-CA TTM, particularly related to optimal timing and depth of TTM and cooling methods. A review of the literature finds that optimizing and individualizing TTM remains an open question requiring further clinical investigation. This paper will summarize the preclinical and clinical trial data to-date, current recommendations, and future directions of this therapy, including new cooling methods under investigation. For now, early induction, maintenance for at least 24 hours, and slow rewarming utilizing endovascular methods may be preferred. Moreover, timely and accurate neuro-prognostication is valuable for guiding ethical and cost-effective management of post-CA coma. Current evidence for early neuro-prognostication after TTM suggests that a combination of initial prediction models, biomarkers, neuroimaging, and electrophysiological methods is the optimal strategy in predicting neurological functional outcomes.

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Section: Neuroimagingmentioning

confidence: 92%