Introduction: Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management (TTM) of post cardiac arrest patients. Yet, studies of different rewarming rates and patient outcomes are limited. The researchers would like to perform a pilot study to investigate post cardiac arrest patients, who were rewarmed with different rewarming rates after 24 hours of hypothermia and their association to neurologic outcomes. Method: The researchers investigated post cardiac arrest patients treated with TTM and rewarmed with a rewarming rate of 0.15°C/h and 0.25°C/h. The association of rewarming rate and poor neurologic outcome(CPC3-5) was investigated. Result: A total of 63 patients were analyzed (0.15°C/h N=33, 0.25/h N=30). When comparing the neurologic outcomes of 0.15°C/h versus 0.25°C/h, the neurologic outcome did not significantly differ between the two rewarming rates (22(66.7) vs. 20 (66.7), p=1.00). Rewarming rate of 0.15°C/h was not associated with one-month neurologic outcomes, after adjusting confounding factors in the multivariate analysis (OR 1.19 (0.31-4.54), p=0.80). Conclusion: Although the sample size was limited, findings of this pilot study showed that rewarming rates of 0.15°C/h and 0.25°C/h were not associated with different neurologic outcomes in the post cardiac arrest patients.

Objective This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients. Methods Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined. Results Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes. Conclusion Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.