Relationship between time related serum albumin concentration, optic nerve sheath diameter, cerebrospinal fluid pressure, and neurological prognosis in cardiac arrest survivors

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

“…In our study, the median time from ROSC to CT scan was 79.0 min (range 43.0-129.0 min), and the prognostic predictive performance was the lowest among the brain imaging methods evaluated. Moreover, this method has low sensitivity, and drawbacks of significant deviation depending on the interpreter [8]. However, MRI has been shown to predict hypoxic-ischemic brain injury (HIBI), proving that its CA prediction ability of comatose survivors after ROSC is superior to that of CT [8,10,15].…”

“…Moreover, this method has low sensitivity, and drawbacks of significant deviation depending on the interpreter [8]. However, MRI has been shown to predict hypoxic-ischemic brain injury (HIBI), proving that its CA prediction ability of comatose survivors after ROSC is superior to that of CT [8,10,15]. Cortical laminar necrosis of the brain may be identified within hours of the anoxic-ischemic event, and MR-DWI offers good visualization of laminar necrosis and other characteristic signs of hypoxic injury with unsurpassed promptness [15].…”

“…As a qualitative method, we used the presence of abnormal HSI in DWI. Recent studies showed that MRI can predict neurologic outcomes as early as 3 h after ROSC [8,13,15]. Several animal experiments have shown that HSI in DWI can be observed within 1 h of blood flow loss [19,20].…”

“…Recently, combinations of different prognostic predictive methods have been tested to improve prognostic performance [7][8][9]. However, which of these combinations is most accurate for prognostic prediction remains unclear.…”

“…We previously reported that neuron-specific enolase in cerebrospinal fluid (CSF NSE) predicts the prognosis of patients with CA [10] and we reported that results of brain computed tomography (CT) and magnetic resonance imaging (MRI) prior to TTM can be used to predict prognosis in CA survivors [8]. In this study, we hypothesized that combining the NSE level and brain images of CA survivors who had undergone TTM immediately after ROSC may have better prognostic performance than any single analysis.…”