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Prognostic accuracy of head computed tomography for prediction of functional outcome after out-of-hospital cardiac arrest : Rationale and design of the prospective TTM2-CT-substudy

Lang, Margareta LU ; Leithner, Christoph ; Scheel, Michael ; Kenda, Martin ; Cronberg, Tobias LU ; During, Joachim LU orcid ; Rylander, Christian ; Annborn, Martin LU ; Dankiewicz, Josef LU orcid and Deye, Nicolas , et al. (2022) In Resuscitation Plus 12.
Abstract

Background: Head computed tomography (CT) is a guideline recommended method to predict functional outcome after cardiac arrest (CA), but standardized criteria for evaluation are lacking. To date, no prospective trial has systematically validated methods for diagnosing hypoxic-ischaemic encephalopathy (HIE) on CT after CA. We present a protocol for validation of pre-specified radiological criteria for assessment of HIE on CT for neuroprognostication after CA. Methods/design: This is a prospective observational international multicentre substudy of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Patients still unconscious 48 hours post-arrest at 13 participating hospitals were... (More)

Background: Head computed tomography (CT) is a guideline recommended method to predict functional outcome after cardiac arrest (CA), but standardized criteria for evaluation are lacking. To date, no prospective trial has systematically validated methods for diagnosing hypoxic-ischaemic encephalopathy (HIE) on CT after CA. We present a protocol for validation of pre-specified radiological criteria for assessment of HIE on CT for neuroprognostication after CA. Methods/design: This is a prospective observational international multicentre substudy of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Patients still unconscious 48 hours post-arrest at 13 participating hospitals were routinely examined with CT. Original images will be evaluated by examiners blinded to clinical data using a standardized protocol. Qualitative assessment will include evaluation of absence/presence of “severe HIE”. Radiodensities will be quantified in pre-specified regions of interest for calculation of grey-white matter ratios (GWR) at the basal ganglia level. Functional outcome will be dichotomized into good (modified Rankin Scale 0–3) and poor (modified Rankin Scale 4–6) at six months post-arrest. Prognostic accuracies for good and poor outcome will be presented as sensitivities and specificities with 95% confidence intervals (using pre-specified cut-offs for quantitative analysis), descriptive statistics (Area Under the Receiver Operating Characteristics Curve), inter- and intra-rater reliabilities according to STARD guidelines. Conclusions: The results from this prospective trial will validate a standardized approach to radiological evaluations of HIE on CT for prediction of functional outcome in comatose CA patients. The TTM2 trial and the TTM2 CT substudy are registered at ClinicalTrials.gov NCT02908308 and NCT03913065.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cardiac arrest, Computed tomography, GWR grey-white matter ratio, Hypoxic-ischaemic encephalopathy (HIE), Neuroprognostication, Outcome, Targeted temperature management
in
Resuscitation Plus
volume
12
article number
100316
publisher
Elsevier
external identifiers
  • pmid:36267356
  • scopus:85140012278
ISSN
2666-5204
DOI
10.1016/j.resplu.2022.100316
language
English
LU publication?
yes
id
18407fb7-f49f-486a-87ac-738285c34157
date added to LUP
2022-12-07 09:30:07
date last changed
2024-04-15 21:02:35
@article{18407fb7-f49f-486a-87ac-738285c34157,
  abstract     = {{<p>Background: Head computed tomography (CT) is a guideline recommended method to predict functional outcome after cardiac arrest (CA), but standardized criteria for evaluation are lacking. To date, no prospective trial has systematically validated methods for diagnosing hypoxic-ischaemic encephalopathy (HIE) on CT after CA. We present a protocol for validation of pre-specified radiological criteria for assessment of HIE on CT for neuroprognostication after CA. Methods/design: This is a prospective observational international multicentre substudy of the Targeted Hypothermia versus Targeted Normothermia after out-of-hospital cardiac arrest (TTM2) trial. Patients still unconscious 48 hours post-arrest at 13 participating hospitals were routinely examined with CT. Original images will be evaluated by examiners blinded to clinical data using a standardized protocol. Qualitative assessment will include evaluation of absence/presence of “severe HIE”. Radiodensities will be quantified in pre-specified regions of interest for calculation of grey-white matter ratios (GWR) at the basal ganglia level. Functional outcome will be dichotomized into good (modified Rankin Scale 0–3) and poor (modified Rankin Scale 4–6) at six months post-arrest. Prognostic accuracies for good and poor outcome will be presented as sensitivities and specificities with 95% confidence intervals (using pre-specified cut-offs for quantitative analysis), descriptive statistics (Area Under the Receiver Operating Characteristics Curve), inter- and intra-rater reliabilities according to STARD guidelines. Conclusions: The results from this prospective trial will validate a standardized approach to radiological evaluations of HIE on CT for prediction of functional outcome in comatose CA patients. The TTM2 trial and the TTM2 CT substudy are registered at ClinicalTrials.gov NCT02908308 and NCT03913065.</p>}},
  author       = {{Lang, Margareta and Leithner, Christoph and Scheel, Michael and Kenda, Martin and Cronberg, Tobias and During, Joachim and Rylander, Christian and Annborn, Martin and Dankiewicz, Josef and Deye, Nicolas and Halliday, Thomas and Lascarrou, Jean Baptiste and Matthew, Thomas and McGuigan, Peter and Morgan, Matt and Thomas, Matthew and Ullén, Susann and Undén, Johan and Nielsen, Niklas and Moseby-Knappe, Marion}},
  issn         = {{2666-5204}},
  keywords     = {{Cardiac arrest; Computed tomography; GWR grey-white matter ratio; Hypoxic-ischaemic encephalopathy (HIE); Neuroprognostication; Outcome; Targeted temperature management}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Resuscitation Plus}},
  title        = {{Prognostic accuracy of head computed tomography for prediction of functional outcome after out-of-hospital cardiac arrest : Rationale and design of the prospective TTM2-CT-substudy}},
  url          = {{http://dx.doi.org/10.1016/j.resplu.2022.100316}},
  doi          = {{10.1016/j.resplu.2022.100316}},
  volume       = {{12}},
  year         = {{2022}},
}