The Association of Findings on Brain Computed Tomography with Neurologic Outcomes Following Extracorporeal Cardiopulmonary Resuscitation

Overview

Journal Crit Care

Specialty Critical Care

Date 2017 Jan 26

PMID 28118848

Citations 21

Authors

Jeong-Am Ryu

Chi Ryang Chung

Yang Hyun Cho

Kiick Sung

Gee Young Suh

Taek Kyu Park

Young Bin Song

Joo-Yong Hahn

Jin-Ho Choi

Hyeon-Cheol Gwon

Seung-Hyuk Choi

Jeong Hoon Yang

Affiliations

Soon will be listed here.

Abstract

Background: Limited 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.

Methods: Between 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.

Results: Of 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).

Conclusions: GWR, 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.

Citing Articles

Optic Nerve Sheath Diameter in Predicting the Neurological Outcomes of Cardiac Arrest Survivors: A Systematic Review and Meta-analysis.

Jafari Khouzani P, Rahmani E, Rezaei M, Pohrbagher Benam S, Moghadam Fard A, Amani-Beni R Arch Acad Emerg Med. 2025; 13(1):e29.

PMID: 40027220 PMC: 11868668. DOI: 10.22037/aaemj.v13i1.2486.

What factors are effective on the CPR duration of patients under extracorporeal cardiopulmonary resuscitation: a single-center retrospective study.

Vahedian-Azimi A, Fawzy Hassan I, Rahimi-Bashar F, Elmelliti H, Akbar A, Shehata A Int J Emerg Med. 2024; 17(1):56.

PMID: 38632515 PMC: 11022486. DOI: 10.1186/s12245-024-00608-2.

Prognostic effects of cardiopulmonary resuscitation (CPR) start time and the interval between CPR to extracorporeal cardiopulmonary resuscitation (ECPR) on patient outcomes under extracorporeal membrane oxygenation (ECMO): a single-center,....

Vahedian-Azimi A, Fawzy Hassan I, Rahimi-Bashar F, Elmelliti H, Salesi M, Alqahwachi H BMC Emerg Med. 2024; 24(1):36.

PMID: 38438853 PMC: 10913290. DOI: 10.1186/s12873-023-00905-8.

Machine learning-based predictor for neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation.

Kim T, Ahn J, Ryu J Front Cardiovasc Med. 2023; 10:1278374.

PMID: 38045915 PMC: 10691482. DOI: 10.3389/fcvm.2023.1278374.

Both decreased and increased grey-to-white matter attenuation ratio in the putamen and caudate on early head computed tomography differentiate patients with favorable and unfavorable outcomes after prolonged cardiac arrest-secondary analysis of the....

Hrdlicka J, Smalcova J, Bircakova B, Lambert L, Belohlavek J, Burgetova A Quant Imaging Med Surg. 2023; 13(9):6205-6214.

PMID: 37711820 PMC: 10498256. DOI: 10.21037/qims-23-430.

References

Sakamoto T, Morimura N, Nagao K, Asai Y, Yokota H, Nara S . Extracorporeal cardiopulmonary resuscitation versus conventional cardiopulmonary resuscitation in adults with out-of-hospital cardiac arrest: a prospective observational study. Resuscitation. 2014; 85(6):762-8. DOI: 10.1016/j.resuscitation.2014.01.031. View

Hirsch K, Mlynash M, Jansen S, Persoon S, Eyngorn I, Krasnokutsky M . Prognostic value of a qualitative brain MRI scoring system after cardiac arrest. J Neuroimaging. 2014; 25(3):430-7. DOI: 10.1111/jon.12143. View

Shin T, Choi J, Jo I, Sim M, Song H, Jeong Y . Extracorporeal cardiopulmonary resuscitation in patients with inhospital cardiac arrest: A comparison with conventional cardiopulmonary resuscitation. Crit Care Med. 2010; 39(1):1-7. DOI: 10.1097/CCM.0b013e3181feb339. View

Metter R, Rittenberger J, Guyette F, Callaway C . Association between a quantitative CT scan measure of brain edema and outcome after cardiac arrest. Resuscitation. 2011; 82(9):1180-5. PMC: 3244968. DOI: 10.1016/j.resuscitation.2011.04.001. View

Lee Y, Oh Y, Ahn H, Kim H, Han S, Lee J . The prognostic value of the grey-to-white matter ratio in cardiac arrest patients treated with extracorporeal membrane oxygenation. Resuscitation. 2015; 99:50-5. DOI: 10.1016/j.resuscitation.2015.11.009. View

Massetti M, Tasle M, Le Page O, Deredec R, Babatasi G, Buklas D . Back from irreversibility: extracorporeal life support for prolonged cardiac arrest. Ann Thorac Surg. 2004; 79(1):178-83. DOI: 10.1016/j.athoracsur.2004.06.095. View

Kim Y, Lee J, Hong C, Cho K, Hoon Yeo J, Kang M . Feasibility of optic nerve sheath diameter measured on initial brain computed tomography as an early neurologic outcome predictor after cardiac arrest. Acad Emerg Med. 2014; 21(10):1121-8. DOI: 10.1111/acem.12477. View

Cummins R, Chamberlain D, Abramson N, Allen M, Baskett P, Becker L . Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein Style. A statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and.... Circulation. 1991; 84(2):960-75. DOI: 10.1161/01.cir.84.2.960. View

Young G . Clinical practice. Neurologic prognosis after cardiac arrest. N Engl J Med. 2009; 361(6):605-11. DOI: 10.1056/NEJMcp0903466. View

10.

Naples R, Ellison E, Brady W . Cranial computed tomography in the resuscitated patient with cardiac arrest. Am J Emerg Med. 2008; 27(1):63-67. DOI: 10.1016/j.ajem.2008.01.014. View

11.

Samaniego E, Mlynash M, Finley Caulfield A, Eyngorn I, Wijman C . Sedation confounds outcome prediction in cardiac arrest survivors treated with hypothermia. Neurocrit Care. 2010; 15(1):113-9. PMC: 3153345. DOI: 10.1007/s12028-010-9412-8. View

12.

Nagao K, Kikushima K, Watanabe K, Tachibana E, Tominaga Y, Tada K . Early induction of hypothermia during cardiac arrest improves neurological outcomes in patients with out-of-hospital cardiac arrest who undergo emergency cardiopulmonary bypass and percutaneous coronary intervention. Circ J. 2009; 74(1):77-85. DOI: 10.1253/circj.cj-09-0502. View

13.

Megarbane B, Leprince P, Deye N, Resiere D, Guerrier G, Rettab S . Emergency feasibility in medical intensive care unit of extracorporeal life support for refractory cardiac arrest. Intensive Care Med. 2007; 33(5):758-764. DOI: 10.1007/s00134-007-0568-4. View

14.

Kang M, Lee T, Shin T, Sim M, Jo I, Song K . Survival and neurologic outcomes of out-of-hospital cardiac arrest patients who were transferred after return of spontaneous circulation for integrated post-cardiac arrest syndrome care: the another feasibility of the cardiac arrest center. J Korean Med Sci. 2014; 29(9):1301-7. PMC: 4168186. DOI: 10.3346/jkms.2014.29.9.1301. View

15.

Ruopp M, Perkins N, Whitcomb B, Schisterman E . Youden Index and optimal cut-point estimated from observations affected by a lower limit of detection. Biom J. 2008; 50(3):419-30. PMC: 2515362. DOI: 10.1002/bimj.200710415. View

16.

Maekawa K, Tanno K, Hase M, Mori K, Asai Y . Extracorporeal cardiopulmonary resuscitation for patients with out-of-hospital cardiac arrest of cardiac origin: a propensity-matched study and predictor analysis. Crit Care Med. 2013; 41(5):1186-96. DOI: 10.1097/CCM.0b013e31827ca4c8. View

17.

Neumar R, Shuster M, Callaway C, Gent L, Atkins D, Bhanji F . Part 1: Executive Summary: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2015; 132(18 Suppl 2):S315-67. DOI: 10.1161/CIR.0000000000000252. View

18.

Cummins R, Chamberlain D, Hazinski M, Nadkarni V, Kloeck W, Kramer E . Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. Circulation. 1997; 95(8):2213-39. DOI: 10.1161/01.cir.95.8.2213. View

19.

Langkjaer S, Hassager C, Kjaergaard J, Salam I, Thomsen J, Lippert F . Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients. Resuscitation. 2015; 92:141-7. DOI: 10.1016/j.resuscitation.2015.03.023. View

20.

Sekhon M, Griesdale D, Robba C, McGlashan N, Needham E, Walland K . Optic nerve sheath diameter on computed tomography is correlated with simultaneously measured intracranial pressure in patients with severe traumatic brain injury. Intensive Care Med. 2014; 40(9):1267-74. DOI: 10.1007/s00134-014-3392-7. View