Background and Purpose. The gray-to-white matter ratio (GWR) on brain computed tomography (CT) is associated with neurological outcomes after cardiac arrest (CA); however, the prognostic value of GWR in CA patients has yet to be confirmed. Therefore, we conducted a meta-analysis of related studies to investigate the prognostic value of GWR on brain CT for neurological outcomes after CA. Materials and Methods. The PubMed, ScienceDirect, Web of Science, and China National Knowledge Infrastructure databases were searched for all relevant articles published before March 31, 2020, without any language restrictions. The pooled odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with a random-effects model using Stata 14.0 software. Result. A total of 24 eligible studies with 2812 CA patients were recruited in the meta-analysis. The pooled result showed that decreased GWR was correlated with poor neurological outcomes after CA ( OR = 11.28 , 95% CI: 6.29–20.21, and P < 0.001 ) with moderate heterogeneity ( I 2 = 71.5 % , P < 0.001 ). The pooled sensitivity and specificity were 0.58 (95% CI: 0.47–0.68) and 0.95 (95% CI: 0.87–0.98), respectively. The area under the curve (AUC) of GWR was 0.84 (95% CI: 0.80–0.87). Compared with GWR (cerebrum) and GWR (average), GWR using the basal ganglion level of brain CT had the highest AUC of 0.87 (0.84–0.90). Subgroup analysis indicated that heterogeneity may be derived from the time of CT measurement, preset specificity, targeted temperature management, or proportion of cardiac etiology. Sensitivity analysis indicated that the result was stable, and Deeks’ plot showed no possible publication bias ( P = 0   .64 ). Conclusion. Current research suggests that GWR, especially using the basal ganglion level of brain CT, is a useful parameter for determining neurological outcomes after CA.

Background. This study is aimed at determining the predictive value of the gray-matter–white-matter ratio (GWR) on brain computed tomography for delayed encephalopathy after acute carbon monoxide (CO) poisoning (DEACMP). Methods. This retrospective cohort study reviewed 352 patients with acute CO poisoning and who underwent the brain computed tomography test. These patients were admitted to Cangzhou Central Hospital from May 2010 to May 2020. The patients were divided into the DEACMP ( n = 16 ) and non-DEACMP ( n = 336 ) groups. Pearson’s correlation coefficients were computed for correlation analysis. The predictive value of GWR for DEACMP was evaluated by using logistic regression analysis and receiver operator characteristic curves. Results. The morbidity of DEACMP was 4.5% (16/352). The GWR-basal ganglia, GWR-cerebrum, and GWR-average in the DEACMP group were lower than those in the non-DEACMP group. Correlation analysis indicated that GWR-basal ganglia ( r = 0.276 ; P < 0.001 ), GWR-cerebrum ( r = 0.163 ; P = 0.002 ), and GWR-average ( r = 0.20 0; P < 0.001 ) were correlated with DEACMP. Multivariate logistic regression analysis revealed that reduced GWR-basal ganglia, GWR-cerebrum, and GWR-average were independent risk factors ( P < 0.001 ; P = 0.008 ; P = 0.001 ; respectively). Compared with GWR-cerebrum and GWR-average, GWR-basal ganglia had a higher area under the curve of 0.881 (95% confidence interval: 0.783–0.983) with sensitivity and specificity of 93.8% and 68.7%, respectively. The cut-off value of GWR-basal ganglia was 1.055. Conclusion. GWR, especially GWR-basal ganglia, is an early useful predictor for DEACMP.

Purpose: This study investigated the effect of real-time feedback on the restoration of spontaneous circulation, survival to hospital discharge, and favorable functional outcomes after hospital discharge. Methods: PubMed, ScienceDirect, and China National Knowledge Infrastructure databases were searched to screen the relevant studies up to June 2020. Fixed-effects or random-effects model were used to calculate the pooled estimates of relative ratios (RRs) with 95% confidence intervals (CIs). Results: Ten relevant articles on 4281 cardiac arrest cases were identified. The pooled analyses indicated that real-time feedback did not improve restoration of spontaneous circulation (RR: 1.13, 95% CI: 0.92–1.37, and P = .24; I 2 = 81%; P < .001), survival to hospital discharge (RR: 1.27, 95% CI: 0.90–1.79, and P = .18; I 2 = 74%; P < .001), and favorable neurological outcomes after hospital discharge (RR: 1.09, 95% CI: 0.87–1.38; P = .45; I 2 = 16%; P = .31). The predefined subgroup analysis showed that the sample size and arrest location may be the origin of heterogeneity. Begg’s and Egger’s tests showed no publication bias, and sensitivity analysis indicated that the results were stable. Conclusion: The meta-analysis had shown that the implementation of real-time audiovisual feedback was not associated with improved restoration of spontaneous circulation, increased survival, and favorable functional outcomes after hospital discharge.