scholarly journals Brain Magnetic Resonance Imaging in Patients with Favorable Outcomes after Out-of-Hospital Cardiac Arrest: Many Have Encephalopathy Even with a Good Cerebral Performance Category Score

2015 ◽  
Vol 30 (4) ◽  
pp. 265-271
Author(s):  
Woo Sung Choi ◽  
Jin Joo Kim ◽  
Hyuk Jun Yang
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Arrest ◽  
Magnetic Resonance ◽  
Cerebral Performance Category ◽  
Brain Magnetic Resonance Imaging ◽  
Resonance Imaging ◽  
Performance Category ◽  
Cerebral Performance Category Score ◽  
Hospital Cardiac Arrest ◽  
Category Score

scholarly journals Prognostication of neurologic outcome using gray-white-matter-ratio in comatose patients after cardiac arrest

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Konrad Kirsch ◽  
Stefan Heymel ◽  
Albrecht Günther ◽  
Kathleen Vahl ◽  
Thorsten Schmidt ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
White Matter ◽  
Circulatory Arrest ◽  
Cerebral Performance Category ◽  
Time Interval ◽  
Performance Category ◽  
Neurologic Outcomes ◽  
Ischaemic Brain ◽  
Cerebral Performance Category Score ◽  
Category Score

Abstract Background This study aimed to assess the prognostic value regarding neurologic outcome of CT neuroimaging based Gray-White-Matter-Ratio measurement in patients after resuscitation from cardiac arrest. Methods We retrospectively evaluated CT neuroimaging studies of 91 comatose patients resuscitated from cardiac arrest and 46 non-comatose controls. We tested the diagnostic performance of Gray-White-Matter-Ratio compared with established morphologic signs of hypoxic-ischaemic brain injury, e. g. loss of distinction between gray and white matter, and laboratory parameters, i. e. neuron-specific enolase, for the prediction of poor neurologic outcomes after resuscitated cardiac arrest. Primary endpoint was neurologic function assessed with cerebral performance category score 30 days after the index event. Results Gray-White-Matter-Ratio showed encouraging interobserver variability (ICC 0.670 [95% CI: 0.592–0.741] compared to assessment of established morphologic signs of hypoxic-ischaemic brain injury (Fleiss kappa 0.389 [95% CI: 0.320–0.457]) in CT neuroimaging studies. It correlated with cerebral performance category score with lower Gray-White-Matter-Ratios associated with unfavourable neurologic outcomes. A cut-off of 1.17 derived from the control population predicted unfavourable neurologic outcomes in adult survivors of cardiac arrest with 100% specificity, 50.3% sensitivity, 100% positive predictive value, and 39.3% negative predictive value. Gray-White-Matter-Ratio prognostic power depended on the time interval between circulatory arrest and CT imaging, with increasing sensitivity the later the image acquisition was executed. Conclusions A reduced Gray-White-Matter-Ratio is a highly specific prognostic marker of poor neurologic outcomes early after resuscitation from cardiac arrest. Sensitivity seems to be dependent on the time interval between circulatory arrest and image acquisition, with limited value within the first 12 h.

scholarly journals The Usefulness of Quantitative Analysis of Blood-Brain Barrier Disruption Measured Using Contrast-Enhanced Magnetic Resonance Imaging to Predict Neurological Prognosis in Out-of-Hospital Cardiac Arrest Survivors: A Preliminary Study

2020 ◽  
Vol 9 (9) ◽  
pp. 3013
Author(s):  
Ho Il Kim ◽  
In Ho Lee ◽  
Jung Soo Park ◽  
Da Mi Kim ◽  
Yeonho You ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Cardiac Arrest ◽  
Magnetic Resonance ◽  
Neurological Outcome ◽  
Resonance Imaging ◽  
Neurological Outcomes ◽  
Outcome Group ◽  
Contrast Enhanced ◽  
Poor Neurological Outcome ◽  
Hospital Cardiac Arrest

We aimed to evaluate neurological outcomes associated with blood-brain barrier (BBB) disruption using contrast-enhanced magnetic resonance imaging (CE-MRI) in out-of-hospital cardiac arrest (OHCA) survivors. This retrospective observational study involved OHCA survivors who had undergone CE-MRI for prognostication. Qualitative and quantitative analyses were performed using the presence of BBB disruption (pBD) and the BBB disruption score (sBD) in CE-MRI scans, respectively. For the sBD, 1 point was assigned for each area of BBB disruption, and 6 points were assigned when an absence of intracranial blood flow due to severe brain oedema was confirmed. The primary outcome was poor neurological outcome at 3 months (defined as cerebral performance categories 3–5). We analysed 46 CE-MRI brain scans (27 patients). Of these, 15 (55.6%) patients had poor neurological outcomes. Poor neurological outcome group patients showed a significantly higher proportion of pBD than those in the good neurological outcome group (22 (88%) vs. 6 (28.6%) patients, respectively, p < 0.001) and a higher sBD (5.0 (4.0–5.0) vs. 0.0 (0.0–1.0) patients, p < 0.001). Poor neurological outcome predictions showed that the sBD had a significantly better prognostic performance (area under the curve (AUC) 0.95, 95% confidence interval (CI) 0.84–0.99) than the pBD (AUC 0.80, 95% CI 0.65–0.90). The sBD cut-off value was >1 point (sensitivity, 96.0%; specificity, 81.0%). The sBD is a highly predictive and sensitive marker of 3-month poor neurological outcome in OHCA survivors. Multicentre prospective studies are required to determine the generalisability of these results.

Abstract 82: Mechanical CPR Is Associated with Poor Neurologically Intact Survival in a Statewide Registry

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Scott Youngquist ◽  
Patrick Ockerse ◽  
Chris Stratford ◽  
Peter Taillac
Keyword(s):  
Cardiac Arrest ◽  
Randomized Trials ◽  
Cerebral Performance Category ◽  
Comparative Performance ◽  
Performance Category ◽  
Neurologically Intact ◽  
Residual Confounding ◽  
Mechanical Cpr ◽  
Hospital Cardiac Arrest ◽  
Category Score

BACKGROUND: Large, randomized trials have concluded that mechanical CPR (mech-CPR) is equivalent to manual CPR (man-CPR) with respect to outcomes from out-of-hospital cardiac arrest (OHCA). However, outside of such well-controlled settings, the performance of mech-CPR is uncertain. We sought to determine the association, if any, between mech-CPR use and outcomes in a large, statewide registry of cardiac arrest. METHODS: The Utah State CARES registry began collecting outcomes on all cardiac arrests in the state of Utah in July of 2012. We analyzed data from this registry to determine the comparative performance of resuscitations utilizing mech-CPR vs man-CPR. Neurologically-intact survival was defined as a Cerebral Performance Category score of 1 or 2. RESULTS: Mech-CPR was performed on 237/1,567 OHCAs (15%) during the 1.5 year period of analysis. The majority of devices used were of the load-distributing band type 213/237 (90%). Neurologically-intact survival was 10/237 (4%) in the cohort receiving mech-CPR vs 149/1,330 (11%) in the cohort receiving man-CPR. When controlling for Utstein variables (TABLE), mech-CPR was associated with significantly reduced odds of neurologically-intact survival, with an adjusted odds ratio 0.4 (95% CI 0.2-0.9). CONCLUSIONS: We observed a statistically significant association between mech-CPR use during resuscitation and reduced odds of neurologically-intact survival in our statewide cardiac arrest database. Outside of randomized trials, the resuscitation performance of mech-CPR devices may suffer from poor implementation or increased application to non-viable survivors. Residual confounding of this observational finding is also possible.

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