Abstract 365: Left Ventricular Wall Findings in Non-Electrocardiography-Gated Contrast-Enhanced Computed Tomography After Extracorporeal Cardiopulmonary Resuscitation

Abstract

Background: Extracorporeal cardiopulmonary resuscitation (ECPR) is a promising treatment for refractory cardiac arrest. Computed tomography (CT) is often performed after ECPR for diagnosis of etiology and evaluation of complications. However, few studies have reported left ventricular wall findings in contrast-enhanced CT (CE-CT) after ECPR. This study examined the left ventricular wall CE-CT findings after ECPR, and evaluated the association between these findings and the results of coronary angiography and prognosis. Method: We evaluated out-of-hospital cardiac arrest patients who were treated with ECPR and then underwent both non-ECG gated CE-CT and coronary angiography at our center between January 2011 and April 2018. The left ventricular wall CE-CT findings at 90 s after contrast injection were classified as follows: homogeneously-enhanced (HE), left ventricular wall was homogeneously enhanced; segmental defect (SD), left ventricular wall was not segmentally enhanced according to coronary artery territory; total defect (TD), entire left ventricular wall was not enhanced; and others. Significant stenosis on coronary angiography, survival to hospital discharge, and successful weaning from extracorporeal membrane oxygenation (ECMO) were examined. Results: A total of 111 patients were eligible. Median age was 59 years, and 85 (77%) had initial shockable rhythm. A total of 37 (33%) survived to hospital discharge. HE was observed in 33 patients, SD in 41, TD in 15, and others in 22. Among 74 patients who underwent CT prior to coronary angiography, SD predicted significant stenosis, with sensitivity of 83% and specificity of 100%. Among all patients, 28 (85%) with HE, 15 (37%) with SD, and 3 (20%) with TD were weaned successfully from ECMO. In addition, 17 (52%) patients with HE, 10 (24%) with SD, and 2 (13%) with TD survived to hospital discharge. Conclusion: SD could predict coronary artery stenosis with good specificity. Patients with HE had higher success rates for weaning from ECMO. On the other hand, TD was associated with poor outcomes. The left ventricular wall findings in non-ECG gated CE-CT after ECPR might be useful in diagnosis and prognostication.