Abstract 407: Utility of Abnormal Head Computed Tomography in Predicting Outcome in Out of Hospital Cardiac Arrest Victims Resuscitated and Subsequently Placed on Targeted Temperature Management

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Michael Bernett ◽  
Robert A Swor
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Survival Analysis ◽  
Interrater Reliability ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Radiology Reports ◽  
Head Computed Tomography ◽  
Hospital Cardiac Arrest

Introduction: Head computed tomography (HCT) is often performed to assess for hypoxic-ischemic brain injury in resuscitated out of hospital cardiac arrest (OHCA) patients. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome post OHCA. Methods: We included subjects from a prospectively collected cardiac arrest database of OHCA adult patients who received targeted temperature management (TTM) at two academic suburban hospitals from 2009-Sept-2018. Cases were included if a HCT was performed in the emergency department (ED). Patient demographics and cardiac arrest variables were collected. HCT results were abstracted by study authors from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, stroke). Outcomes were survival to discharge or cerebral performance scores (CPC) at discharge of three or four (poor neurologic outcome). Descriptive statistics, univariate, multivariate, survival, and interrater reliability analysis were performed. Results: During the study period, there were 425 OHCA, 277 cases had ED HCTs performed; 254 cases were included in the final survival analysis. Patients were predominately male, 189 (65.0%), average age 60.9 years, average BMI of 30.5. Of all cases, 44 (15.9%) showed CE on CT. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (OR: 9.23; 95% CI 1.73, 49.2), and 9.1-fold greater odds of death (OR: 9.09: 95% CI 2.4 33.9). In adjusted analysis, CE was associated with 14.9-fold greater odds of poor CPC outcome (AOR: 14.9, 95% CI, 2.49, 88.4), and 13.7-fold greater odds of death (AOR: 13.7, 95% CI, 3.26, 57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (HR: 3.56: 95% CI 2.34, 5.41). Interrater reliability demonstrated excellent agreement between reviewers for CE on HCT (κ = 0.86). Conclusion: The results identify that abnormal HCTs early in the post-arrest period in OHCA patients are associated with poor rates of survival and neurologic outcome. Prospective work is needed to confirm whether selection bias or other variables confound this association.

Abstract 18656: The Effect of Targeted Temperature Management is Dependent Upon the Duration of Out-of-hospital Cardiac Arrest

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Ian R Drennan ◽  
Steve Lin ◽  
Kevin E Thorpe ◽  
Jason E Buick ◽  
Sheldon Cheskes ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Hospital Discharge ◽  
Spontaneous Circulation ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Injury ◽  
Good Neurologic Outcome ◽  
The Impact ◽  
Hospital Cardiac Arrest

Introduction: Targeted temperature management (TTM) reduces neurologic injury from out-of-hospital cardiac arrest (OHCA). As the risk of neurologic injury increases with prolonged cardiac arrests, the benefit of TTM may depend upon cardiac arrest duration. We hypothesized that there is a time-dependent effect of TTM on neurologic outcomes from OHCA. Methods: Retrospective, observational study of the Toronto RescuNET Epistry-Cardiac Arrest database from 2007 to 2014. We included adult (>18) OHCA of presumed cardiac etiology that remained comatose (GCS<10) after a return of spontaneous circulation. We used multivariable logistic regression to determine the effect of TTM and the duration of cardiac arrest on good neurologic outcome (Modified Rankin Scale (mRS) 0-3) and survival to hospital discharge while controlling for other known predictors. Results: There were 1496 patients who met our inclusion criteria, of whom 981 (66%) received TTM. Of the patients who received TTM, 59% had a good neurologic outcome compared to 39% of patients who did not receive TTM (p< 0.001). After adjusting for the Utstein variables, use of TTM was associated with improved neurologic outcome (OR 1.60, 95% CI 1.10-2.32; p = 0.01) but not with survival to discharge (OR 1.23, 95% CI 0.90-1.67; p = 0.19). The impact of TTM on neurologic outcome was dependent on the duration of cardiac arrest (p<0.05) (Fig 1). Other significant predictors of good neurologic outcome were younger age, public location, initial shockable rhythm, and shorter duration of cardiac arrest (all p values < 0.05). A subgroup analysis found the use of TTM to be associated with neurologic outcome in both shockable (p = 0.01) and non-shockable rhythms (p = 0.04) but was not associated with survival to discharge in either group (p = 0.12 and p = 0.14 respectively). Conclusion: The use of TTM was associated with improved neurologic outcome at hospital discharge. Patients with prolonged durations of cardiac arrest benefited more from TTM.

Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management

Resuscitation ◽  
2017 ◽  
Vol 119 ◽  
pp. 89-94 ◽  
Author(s):  
Marion Moseby-Knappe ◽  
Tommaso Pellis ◽  
Irina Dragancea ◽  
Hans Friberg ◽  
Niklas Nielsen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cardiac Arrest ◽  
Targeted Temperature Management ◽  
Temperature Management ◽  
Poor Outcome ◽  
Head Computed Tomography

Background Frequency Patterns in Standard Electroencephalography During Targeted Temperature Management as an Early Prognostic Tool in Out-of-Hospital Cardiac Arrest Survivors: a retrospective cohort study

2020 ◽  
Author(s):  
Youn-Jung Kim ◽  
Min-jee Kim ◽  
Yong Seo Koo ◽  
Won Young Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Features ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Background Frequency ◽  
Prognostic Tool ◽  
Logistic Analysis ◽  
Good Neurologic Outcome ◽  
Hospital Cardiac Arrest

Abstract Background Electroencephalography is a widely used tool for detecting epileptiform and assessing neurological outcomes after cardiac arrest. We investigated the prognostic value of standard electroencephalography during early post-cardiac arrest period and evaluated the performance of electroencephalography findings combined with other clinical features for predicting good outcome. Methods This observational registry-based study was conducted at tertiary care hospital in Korea. Data of all consecutive adult comatose out-of-hospital cardiac arrest survivors who underwent electroencephalography during targeted temperature management between 2010 and 2018 were extracted. Electroencephalography findings, classified according to the American Clinical Neurophysiological Society critical care electroencephalography terminology, and good neurologic outcome-related clinical features were identified via multivariable logistic analysis. Results Good outcomes were observed in 36.5% of 170 patients. Median electroencephalography time was 22.0 hours. Electroencephalography background, voltage and other findings (burst suppression, reactivity to pain stimuli) significantly differed between good and poor outcome groups. Electroencephalography background with dominant alpha and theta waves had the highest odds ratio of 9.8 (95% confidence interval 3.9-24.9) in multivariable logistic analysis. Electroencephalography background frequency enabled identification of a good neurologic outcome (sensitivity, 83.87%; specificity, 75.93%). Combination of other clinical features (age<65 years, initial shockable rhythm, resuscitation duration<20 min) with electroencephalography findings increased predictive performance for good neurologic outcomes (sensitivity, 95.2%; specificity, 100%). ConclusionsBackground frequency patterns of standard electroencephalography during targeted temperature management may play a role as an early prognostic tool in out-of-hospital cardiac arrest patients.

scholarly journals Thrombotic Microangiopathy Score as a New Predictor for Neurologic Outcome in Patients Undergoing Targeted Temperature Management After Out-of-hospital Cardiac Arrest

2020 ◽  
Author(s):  
Taeyoung Kong ◽  
Hye Sun Lee ◽  
Soyoung Jeon ◽  
Jong Wook Lee ◽  
Hyun Soo Chung ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Thrombotic Microangiopathy ◽  
Morphological Characteristics ◽  
Targeted Temperature Management ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Neurologic Outcomes ◽  
Measured Time ◽  
Automated Hematology Analyzer ◽  
Hospital Cardiac Arrest

Abstract Background: Given the morphological characteristics of schistocytes, thrombotic microangiopathy (TMA) score can be beneficial as it can be quickly and serially measured without additional effort or costs. This study aimed to investigate whether the serial TMA scores until 48 h post admission are associated with clinical outcomes in patients undergoing targeted temperature management (TTM) after out-of-hospital cardiac arrest (OHCA). Methods:We retrospectively evaluated a cohort of 185 patients using a prospective registry. We analyzed the TMA score at admission and after 12, 24, and 48 hours. The primary outcome measures were poor neurologic outcome at discharge and 30-day mortality. Results:Increased TMA scores at all measured time points were independent predictors of poor neurologic outcomes and 30-day mortality, with the TMA score at time-12 showing the strongest correlation (OR, 3.008; 95% CI, 1.707–5.3; p=0.001 and HR, 1.517; 95% CI, 1.196–1.925; p=0.001.Specifically, TMA score ≥2 at time-12 was closely associated with increased predictability of poor neurologic outcome (OR, 6.302; 95% CI: 2.841–13.976; p<0.001) and 30-day mortality (HR, 2.656; 95% CI: 1.675–4.211; p<0.001).Conclusions: Increased TMA scores predicted the neurologic outcome and 30-day mortalityin patients undergoing TTM after OHCA. In addition to the benefit of being quickly and serially measured by using an automated hematology analyzer without additional effort or costs, this finding indicates that the TMA score may be a helpful tool for rapid risk stratification and identification of the need for intensive care in patients with ROSC after OHCA.

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