Association of hypoxic ischemic brain injury on early CT after out of hospital cardiac arrest with neurologic outcome

Schick, Alexandra; Prekker, Matthew E.; Kempainen, Robert R.; Mulder, Maximilian; Moore, Johanna C.; Evans, Danika; Hall, J. R.; Rodinm, Holly; Larson, Jeffrey; Caraganis, A.

doi:10.1016/j.ajem.2022.02.003

Cited by 10 publications

(7 citation statements)

References 35 publications

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“…This assumption is supported by recent work, in which HIBI was reliably identified using deep transfer learning-based analysis of CCT scans acquired within 3 hours of ROSC 41 and the observation that HIBI can be detected on native CCT scans within 2 hours of ROSC. 33 Compared with the blood parameters NSE and NfL, aCCTa outperformed these biomarkers on day 0. The prognostic value of these markers increased subsequently, with NSE outperforming aCCTa on day 2 and NfL already on day 1.…”

Section: Discussionmentioning

confidence: 94%

Analysis of Cerebral CT Based on Supervised Machine Learning as a Predictor of Outcome After Out-of-Hospital Cardiac Arrest

Gramespacher,

Schmieschek,

Warnke

et al. 2024

Neurology

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Background and ObjectivesIn light of limited intensive care capacities and a lack of accurate prognostic tools to advise caregivers and family members responsibly, this study aims to determine whether automated cerebral CT (CCT) analysis allows prognostication after out-of-hospital cardiac arrest. MethodsIn this monocentric, retrospective cohort study, a supervised machine learning classifier based on an elastic net regularized logistic regression model for gray matter alterations on nonenhanced CCT obtained after cardiac arrest was trained using 10-fold cross-validation and tested on a hold-out sample (random split 75%/25%) for outcome prediction. Following the literature, a favorable outcome was defined as a cerebral performance category of 1-2 and a poor outcome of 3-5. The diagnostic accuracy was compared with established and guidelinerecommended prognostic measures within the sample, that is, gray matter-white matter ratio (GWR), neuron-specific enolase (NSE), and neurofilament light chain (NfL) in serum. ResultsOf 279 adult patients, 132 who underwent CCT within 14 days of cardiac arrest with good imaging quality were identified. Our approach discriminated between favorable and poor outcomes with an area under the curve (AUC) of 0.73 (95% CI 0.59-0.82). Thus, the prognostic power outperformed the GWR (AUC 0.66, 95% CI 0.56-0.76). The biomarkers NfL, measured at days 1 and 2, and NSE, measured at day 2, exceeded the reliability of the imaging markers derived from CT (AUC NfL day 1: 0.87, 95% CI 0.75-0.99; AUC NfL day 2: 0.90, 95% CI 0.79-1.00; AUC NSE day: 2 0.78, 95% CI 0.62-0.94). DiscussionOur data show that machine learning-assisted gray matter analysis of CCT images offers prognostic information after out-of-hospital cardiac arrest. Thus, CCT gray matter analysis could become a reliable and time-independent addition to the standard workup with serum biomarkers sampled at predefined time points. Prospective studies are warranted to replicate these findings.

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Section: Discussionmentioning

confidence: 94%

Analysis of Cerebral CT Based on Supervised Machine Learning as a Predictor of Outcome After Out-of-Hospital Cardiac Arrest

Gramespacher,

Schmieschek,

Warnke

et al. 2024

Neurology

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“…The morphological hallmark of a hypoxic-ischemic brain injury on CT is diminished grey-to-white matter differentiation due to cytotoxic edema ( 19 ). This appearance has a high specificity (0.97) but low sensitivity (0.44) for poor neurological outcome ( 19 , 22 ). In our study, apparent cerebral edema equaled an unfavorable outcome, which has also been observed by others ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

“…This appearance has a high specificity (0.97) but low sensitivity (0.44) for poor neurological outcome ( 19 , 22 ). In our study, apparent cerebral edema equaled an unfavorable outcome, which has also been observed by others ( 22 ).…”

Section: Discussionmentioning

confidence: 99%

Both decreased and increased grey-to-white matter attenuation ratio in the putamen and caudate on early head computed tomography differentiate patients with favorable and unfavorable outcomes after prolonged cardiac arrest—secondary analysis of the Prague OHCA study

Hrdlicka,

Smalcova,

Bircakova

et al. 2023

Quant Imaging Med Surg

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Background Neurological damage remains the leading cause of death in cardiac arrest victims with early neuroprognostication being the cornerstone of the decision-making process to continue or discontinue advanced treatments. In this study, we aimed to find markers of favorable and unfavorable outcome on early brain computed tomography (CT) in patients after prolonged out-of-hospital cardiac arrest (OHCA) treated both by conventional and extracorporeal cardiopulmonary resuscitation (ECPR). Methods In a secondary analysis of the Prague OHCA study, patients who underwent brain CT within 36 hours after cardiac arrest were identified. Qualitative findings (brain edema, hemorrhage) and quantitative measurements [attenuation of grey matter structures and grey-to-white matter attenuation ratio (GWR)] between patients with cerebral performance category (CPC) of 1–2 (favorable outcome) and 3–5 (unfavorable outcome) within 180 days after the event were compared. Results In 45 eligible patients, intracranial edema (n=16, 50%) was present in patients with CPC 3–5 only (n=32, 71%). Attenuation of brain structures and GWR did not differ between patients with favorable and unfavorable outcomes. However, the GWR in the caudate and putamen of most CPC 1–2 patients was within a narrow range of values (1.18 to 1.30 and 1.20 to 1.33) that separated patients with CPC 1–2 from CPC 3–5 with a sensitivity of 78% and 66% a specificity of 85% and 100%, and area under the curve （AUC） of 0.86 (P=0.0001) and 0.77 (P=0.0053), respectively. Patients treated by ECPR had lower attenuation in the centrum semiovale (28.3±2.7) compared to those who were not (31.0±2.8, P=0.003). The most common causes of death in CPC 3–5 patients were brain death in 13 (41%) patients, multiorgan failure in 12 (38%), and cardiac rearrest in 4 (13%). Conclusions Both decreased and increased grey-to-white matter differentiation in the putamen and caudate on early non-contrast brain CT after prolonged OHCA indicate poor neurological outcome within 180 days after cardiac arrest.

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“…However, the early presence of diffuse loss of gray-white differentiation, sulcal effacement, and cistern effacement is associated with poor outcomes with low false-positive rates. 250 257 263 The gray-to-white-matter ratio (GWR), a quantitative marker of cytotoxic edema, has shown good predictive value in adults, but pediatric data are limited. 114 250 264 Brain MRI has superior sensitivity for detecting regional injury and, when performed in the first 3 to 7 days following ROSC, may clarify the extent of ABI further.…”

Section: Neuroprognosticationmentioning

confidence: 99%

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

Plante,

Basu,

Gettings

et al. 2024

Semin Neurol

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Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs) worldwide are for neurocritical care diagnoses that are associated with significant morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field with unique challenges due to not only age-related responses to primary neurologic insults and their treatments but also the rarity of pediatric neurocritical care conditions at any given institution. The structure of pediatric neurocritical care services therefore is most commonly a collaborative model where critical care medicine physicians coordinate care and are supported by a multidisciplinary team of pediatric subspecialists, including neurologists. While pediatric neurocritical care lies at the intersection between critical care and the neurosciences, this narrative review focuses on the most common clinical scenarios encountered by pediatric neurologists as consultants in the PICU and synthesizes the recent evidence, best practices, and ongoing research in these cases. We provide an in-depth review of (1) the evaluation and management of abnormal movements (seizures/status epilepticus and status dystonicus); (2) acute weakness and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions); (3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective strategies for which there is evidence (e.g., pediatric severe traumatic brain injury, post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest, and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death by Neurological Criteria. Our review of the current state of pediatric neurocritical care from the viewpoint of what a pediatric neurologist in the PICU needs to know is intended to improve knowledge for providers at the bedside with the goal of better patient care and outcomes.

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Association of hypoxic ischemic brain injury on early CT after out of hospital cardiac arrest with neurologic outcome

Cited by 10 publications

References 35 publications

Analysis of Cerebral CT Based on Supervised Machine Learning as a Predictor of Outcome After Out-of-Hospital Cardiac Arrest

Analysis of Cerebral CT Based on Supervised Machine Learning as a Predictor of Outcome After Out-of-Hospital Cardiac Arrest

Both decreased and increased grey-to-white matter attenuation ratio in the putamen and caudate on early head computed tomography differentiate patients with favorable and unfavorable outcomes after prolonged cardiac arrest—secondary analysis of the Prague OHCA study

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

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