Abstract
BackgroundMild therapeutic hypothermia alters the validity of a number of parameters currently used to predict neurological outcome after cardiac arrest and resuscitation. Thus, additional parameters are needed to increase certainty of early prognosis in these patients. A promising new approach is the determination of the gray-white-matter ratio (GWR) in cranial computed tomography (CCT) obtained early after resuscitation. It is not known how GWR relates to established outcome parameters such as neuron specific enolase (NSE) or somatosensory evoked potentials (SSEP).MethodsCardiac arrest patients (n = 98) treated with hypothermia were retrospectively analyzed with respect to the prognostic value of GWR, NSE and SSEP.ResultsA GWR < 1.16 predicted poor outcome with 100% specificity and 38% sensitivity. In 62 patients NSE, SSEP and CCT were available. The sensitivity of poor outcome prediction by both NSE > 97 μg/L and bilateral absent SSEP was 43%. The sensitivity increased to 53% in a multi-parameter approach predicting poor outcome using at least two of the three parameters (GWR, NSE and SSEP).ConclusionOur results suggest a strong association of a low GWR with poor outcome following cardiac arrest. Determination of the GWR increases the sensitivity in a multi-parameter approach for prediction of poor outcome after cardiac arrest.
Highlights
An increasing number of recent studies on outcome prognostication after cardiac arrest demonstrate that hypothermia treatment alters prognostic parameters that had been established in normothermic patients
We identified a subgroup of patients (n = 111) that had received cranial computed tomography (CCT) within the first seven days after cardiac arrest
We demonstrated in a subgroup of 62 patients who had received neuron specific enolase (NSE), somatosensory evoked potentials (SSEP) and CCT that a gray-white-matter ratio (GWR) < 1.16 increased the sensitivity of poor outcome detection (from 43% (17/40) to 53% (n = 21/40)) if at least two pathologic test results were required for poor outcome prediction
Summary
An increasing number of recent studies on outcome prognostication after cardiac arrest demonstrate that hypothermia treatment alters prognostic parameters that had been established in normothermic patients. Recent studies have evaluated CT signs, such as cerebral gray-white matter ratio (GWR) as an early prognostic outcome parameter in hypoxic-ischemic encephalopathy [11,12,13,14,15,16]. A promising new approach is the determination of the gray-white-matter ratio (GWR) in cranial computed tomography (CCT) obtained early after resuscitation. It is not known how GWR relates to established outcome parameters such as neuron specific enolase (NSE) or somatosensory evoked potentials (SSEP)
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