Abstract

BackgroundNeurological abnormalities are a key factor in the prognosis of patients with post-cardiac arrest syndrome. In this study, we evaluated whether differences in CT measurements expressed in Hounsfield units (HUs) of the cerebral cortex and white matter can be used as early predictors of neurological outcome in patients treated with hypothermia therapy after hypoxic-ischemic brain damage.MethodsWe performed a retrospective study of 58 patients resuscitated after cardiac arrest between 2007 and 2010 who were treated with hypothermia therapy for the initial 24 hours post resuscitation. We divided the patients into 4 groups according to Glasgow Outcome Scale (GOS) score (GOS 1, GOS 2, GOS 3&4, and GOS 5) and assessed the correlations between GOS scores and HU differences between the cerebral cortex and white matter (DCW).ResultsThe HU values of the cerebral cortex gradually decreased in accordance with worsening of neurological outcome. There were no significant intergroup differences in the HUs of the white matter among the groups. The DCW values were higher in patients with good neurological outcomes. The cut-off value for DCW indicative of poor neurological outcome was less than 5.5 in the GOS 1&2 groups, with a sensitivity of 63% and a specificity of 100%.ConclusionsThis study showed that DCW values may be used for the prediction of neurological outcome of patients with post-cardiac arrest syndrome in the very early phase following the return of spontaneous circulation. Especially, a cut-off value for DCW of less than 5.5 may indicate poor neurological outcome.

Highlights

  • Post-cardiac arrest syndrome consists of several symptoms that resuscitated patients exhibit after cardiac arrest, such as neurological dysfunction, cardiac failure, and respiratory distress [1]

  • From our experience with head computed tomography (CT) findings in such patients, we found that patients with hypoxic-ischemic brain damage following cardiac arrest showed a loss of difference between gray matter (GM) and white matter (WM), diffuse brain swelling, and decreased basal ganglia density [2,3]

  • Torbey et al demonstrated a correlation between GM/WM ratios measured at the level of the basal ganglia and neurological outcomes in patients after return of spontaneous circulation (ROSC) [4]

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Summary

Introduction

Post-cardiac arrest syndrome consists of several symptoms that resuscitated patients exhibit after cardiac arrest, such as neurological dysfunction, cardiac failure, and respiratory distress [1]. Head computed tomography (CT) is often performed early following ROSC to evaluate brain hemorrhage or infarction in post-cardiac arrest patients. From our experience with head CT findings in such patients, we found that patients with hypoxic-ischemic brain damage following cardiac arrest showed a loss of difference between gray matter (GM) and white matter (WM), diffuse brain swelling, and decreased basal ganglia density [2,3]. We evaluated whether differences in CT measurements expressed in Hounsfield units (HUs) of the cerebral cortex and white matter can be used as early predictors of neurological outcome in patients treated with hypothermia therapy after hypoxic-ischemic brain damage

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