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

Abstract

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.

Prognostic Value of Early Intermittent Electroencephalography in Patients After Extracorporeal Cardiopulmonary Resuscitation

“…Sedation may confuse outcome prediction in survivors of cardiac arrest [1,8,20]. Sedatives are commonly used in survivors after cardiac arrest for 72 hours as important confounders [1,20].…”

“…Sedation may confuse outcome prediction in survivors of cardiac arrest [1,8,20]. Sedatives are commonly used in survivors after cardiac arrest for 72 hours as important confounders [1,20]. A motor response to noxious stimuli, corneal reflex, caloric testing, and some electrophysiologic studies may also be confounded by sedation [20,21].…”

Neurologic Complications and Neuromonitoring on ECMO

“…This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ECMO management is still in its infancy, although a study showed that higher ONSD was associated with poor neurological outcome after ECPR [69].…”

Prognostic Value of Optic Nerve Sheath Diameter in Patients after Extracorporeal Cardiopulmonary Resuscitation

“…Patients who underwent ECPR during the study period were included. Those who were unconscious (a score of < 9 on Glasgow Coma Scale) 16) on admission to the hospital after cardiac arrest and those who were given brain CT scan within 48 hours after ECPR were selected. Of these patients, we excluded patients who were under 18 years of age, those who had malignancy whose expected life span was less than one year, those who had insufficient medical records, and those who had a history of head trauma, neurosurgery, or chronic neurological abnormality on ICU admission.…”

“…ECMO flow was then gradually increased until the patient was hemodynamically stable. Resuscitation was performed in the same way as described in our previous study 16,17) . Arrest to ECMO pump-on time was defined as the time from cardiac arrest to the time at which the ECMO pump was turned on.…”