3 years ago

Computed Tomography Perfusion Aides in the Prognostication of Comatose Post-Cardiac Arrest Patients

Early assessment of the potential for neurological recovery in comatose cardiac arrest patients has been a challenge despite significant evolution in management and imaging techniques. The purpose of study was to determine if the use of CT Perfusion in comatose cardiac arrest patients (CCAP) is feasible and if this technique can predict the likelihood that CCAP will have a devastating outcome at hospital discharge. We prospectively enrolled 10 newly admitted comatose adults who have suffered an out-of-hospital cardiac arrest and were treated with standard therapeutic hypothermia protocols. Patients underwent CTP of the head within 6 hours after finishing therapeutic hypothermia treatment. The imaging findings were compared with the results of a clinical assessment as well as the Modified Rankin score (mRS) at hospital discharge. Sensitivity, specificity, positive, and negative predictive values for CTP were calculated in order to predict clinical outcome. Eight patients had a mRS of ≥5 and two had a mRS of ≤2 at hospital discharge. CTP predicted a good clinical outcome in both patients with a mRS ≤2. The AUC for plain CT head, CTA 4 point scale, CTA 7 point scale, CTP whole brain and CTP brainstem for predicting the results of the immediate clinical assessment were 0.76, 0.83, 0.67, 0.83 and 1, respectively. The AUC for predicting outcome at discharge were 0.69, 0.63, 0.56, 0.63, 0.63 and 0.69 respectively. In conclusion, our pilot study showed that CTP is feasible and had very high AUC for predicting the results of immediate clinical assessment in CCAP.

Publisher URL: www.sciencedirect.com/science

DOI: S000291491830047X

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