Abstract
Predicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. Subjects were non-traumatic, out-of-hospital CA patients < 16 years of age who underwent the first head CT within 24 h in our institute from 2006 to 2018 (n = 70, median age: 4 months, range 0–163). Of the 24 patients with return of spontaneous circulation, 14 survived up to 30 days after CA. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-to-white-matter-attenuation ratio (sGWR). The 14 survivors showed higher mASPECTS values than the 56 non-survivors (p = 0.035). All 3 patients with mASPECTS scores ≥ 20 survived, while an sGWR ≥ 1.14 indicated a higher chance of survival than an sGWR < 1.14 (54.5% vs. 13.6%). Follow-up magnetic resonance imaging for survivors validated the correlation of the mASPECTS < 15 with severe brain damage. Thus, low mASPECTS scores were associated with unfavorable neurological outcomes on the Pediatric Cerebral Performance Category scale. A quantitative analysis of early head CT findings might provide clues for predicting survival of pediatric CA.
Highlights
Predicting outcomes of children after cardiac arrest (CA) remains challenging
Neurological disabilities among the 14 survivors were assessed according to the Pediatric Cerebral Performance Category (PCPC) scale (Table S2)
We showed that the first-day computed tomography (CT) findings provided useful parameters for the quantitative analysis of the brain damage sustained after CA in pediatric patients
Summary
Predicting outcomes of children after cardiac arrest (CA) remains challenging. To identify useful prognostic markers for pediatric CA, we retrospectively analyzed the early findings of head computed tomography (CT) of patients. The degree of brain damage was quantitatively measured with modified methods of the Alberta Stroke Program Early CT Score (mASPECTS) and simplified gray-matter-attenuation-towhite-matter-attenuation ratio (sGWR). The gray matter attenuation-to-white matter attenuation ratio (GWR) and Alberta Stroke Program Early CT Score (ASPECTS) are established indices for early ischemic change on CT images and for neurological outcomes after stroke[5,6,7]. The simplified GWR (sGWR) in four ROIs is associated with the outcome of post-CA adults[5] These evaluation systems have been mainly applied for adult CA, and prognostic indexes remain to be established for pediatric patients with C A8. Months, median, range Male PCPC before CA, median, range Underlying disease CHD Non-CHD At detection Bystander CPR CPR < 1 h from CAa Witness of collapse Shockable rhythmb (EMS) On admission ROSC Shockable rhythm At hospital discharge Median hospital stay (days), range Median PCPC, range
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