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

Moseby-Knappe, Marion LU ; Pellis, Tommaso; Dragancea, Irina LU ; Friberg, Hans LU ; Nielsen, Niklas LU ; Horn, Janneke; Kuiper, Michael; Roncarati, Andrea; Siemund, Roger LU and Undén, Johan LU , et al. (2017) In Resuscitation 119. p.89-94
Abstract

INTRODUCTION: A multimodal approach to prognostication of outcome after cardiac arrest (CA) is recommended. Evidence for combinations of methods is low. In this post-hoc analysis we described findings on head computed tomography (CT) after CA. We also examined whether generalised oedema on CT alone or together with the biomarker Neuron-specific enolase (NSE) could predict poor outcome.

METHODS: Patients participating in the Target Temperature Management after out-of-hospital-cardiac-arrest-trial underwent CT based on clinical indications. Findings were divided into pre-specified categories according to local radiologists descriptions. Generalised oedema alone and in combination with peak NSE at either 48h or 72h was correlated... (More)

INTRODUCTION: A multimodal approach to prognostication of outcome after cardiac arrest (CA) is recommended. Evidence for combinations of methods is low. In this post-hoc analysis we described findings on head computed tomography (CT) after CA. We also examined whether generalised oedema on CT alone or together with the biomarker Neuron-specific enolase (NSE) could predict poor outcome.

METHODS: Patients participating in the Target Temperature Management after out-of-hospital-cardiac-arrest-trial underwent CT based on clinical indications. Findings were divided into pre-specified categories according to local radiologists descriptions. Generalised oedema alone and in combination with peak NSE at either 48h or 72h was correlated with poor outcome at 6 months follow-up using the Cerebral Performance Category (CPC 3-5).

RESULTS: 356/939 (37.9%) of patients underwent head CT. Initial CT≤24h after CA was normal in 174/218 (79.8%), whilst generalised oedema was diagnosed in 21/218 (9.6%). Between days 1-7, generalised oedema was seen in 65/143 (45.5%), acute/subacute infarction in 27/143 (18.9%) and bleeding in 9/143 (6.3%). Overall, generalised oedema predicted poor outcome with 33.6% sensitivity (95%CI:28.1-39.5) and 98.4% specificity (95%CI:94.3-99.6), whilst peak NSE demonstrated sensitivities of 61.5-64.8% and specificity 95.7% (95%CI:89.5-98.4). The combination of peak NSE>38ng/l and generalised oedema on CT predicted poor outcome with 46.0% sensitivity (95%CI:36.5-55.8) with no false positives. NSE was significantly higher in patients with generalised oedema.

CONCLUSION: In this study, generalised oedema was more common >24h≤7d after CA. The combination of CT and NSE improved sensitivity and specificity compared to CT alone, with no false positives in this limited population.

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Resuscitation
volume
119
pages
89 - 94
publisher
Elsevier
external identifiers
  • scopus:85024401910
  • wos:000408866700027
ISSN
1873-1570
DOI
10.1016/j.resuscitation.2017.06.027
language
English
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yes
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f65abfe9-55be-47b0-bf5d-d6953025707d
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2017-08-14 13:52:13
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2018-10-03 10:53:32
@article{f65abfe9-55be-47b0-bf5d-d6953025707d,
  abstract     = {<p>INTRODUCTION: A multimodal approach to prognostication of outcome after cardiac arrest (CA) is recommended. Evidence for combinations of methods is low. In this post-hoc analysis we described findings on head computed tomography (CT) after CA. We also examined whether generalised oedema on CT alone or together with the biomarker Neuron-specific enolase (NSE) could predict poor outcome.</p><p>METHODS: Patients participating in the Target Temperature Management after out-of-hospital-cardiac-arrest-trial underwent CT based on clinical indications. Findings were divided into pre-specified categories according to local radiologists descriptions. Generalised oedema alone and in combination with peak NSE at either 48h or 72h was correlated with poor outcome at 6 months follow-up using the Cerebral Performance Category (CPC 3-5).</p><p>RESULTS: 356/939 (37.9%) of patients underwent head CT. Initial CT≤24h after CA was normal in 174/218 (79.8%), whilst generalised oedema was diagnosed in 21/218 (9.6%). Between days 1-7, generalised oedema was seen in 65/143 (45.5%), acute/subacute infarction in 27/143 (18.9%) and bleeding in 9/143 (6.3%). Overall, generalised oedema predicted poor outcome with 33.6% sensitivity (95%CI:28.1-39.5) and 98.4% specificity (95%CI:94.3-99.6), whilst peak NSE demonstrated sensitivities of 61.5-64.8% and specificity 95.7% (95%CI:89.5-98.4). The combination of peak NSE&gt;38ng/l and generalised oedema on CT predicted poor outcome with 46.0% sensitivity (95%CI:36.5-55.8) with no false positives. NSE was significantly higher in patients with generalised oedema.</p><p>CONCLUSION: In this study, generalised oedema was more common &gt;24h≤7d after CA. The combination of CT and NSE improved sensitivity and specificity compared to CT alone, with no false positives in this limited population.</p>},
  author       = {Moseby-Knappe, Marion and Pellis, Tommaso and Dragancea, Irina and Friberg, Hans and Nielsen, Niklas and Horn, Janneke and Kuiper, Michael and Roncarati, Andrea and Siemund, Roger and Undén, Johan and Cronberg, Tobias and , },
  issn         = {1873-1570},
  language     = {eng},
  month        = {07},
  pages        = {89--94},
  publisher    = {Elsevier},
  series       = {Resuscitation},
  title        = {Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management},
  url          = {http://dx.doi.org/10.1016/j.resuscitation.2017.06.027},
  volume       = {119},
  year         = {2017},
}