The prognostic value of gray–white matter ratio on brain computed tomography in adult comatose cardiac arrest survivors

Wang, Gannan; Chen, Xu-Feng; Lv, Jinru; Sun, Nana; Xu, Xiao‐Quan; Zhang, Jinsong

doi:10.1016/j.jcma.2018.03.003

Cited by 36 publications

(40 citation statements)

References 18 publications

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“…Fifteen studies assessed the accuracy of the ratio between the densities (in Hounsfield units) of grey matter and white matter (GWR), on brain CT [ 27 , 75 , 78 , 80 – 83 , 86 , 87 , 100 – 103 , 110 , 112 , 115 ]. Densities were sampled in various components of the basal ganglia (caudate, putamen, and thalamus) for the grey matter, in the corpus callosum and in the posterior limb of the internal capsule for the white matter, and in the cerebrum for both (centrum semiovale, upper convexity area).…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, MRI may be less feasible in the early phase after cardiac arrest when there is maximal haemodynamic instability [ 3 ]. Studies included in our review showed that prediction with GWR on brain CT can be obtained up to 72 h [ 87 ] after ROSC. In one study mentioned above [ 85 ], “eye-balling” assessment of generalised oedema on brain CT predicted poor outcome with 56.5 [47–65.7]% sensitivity and 0 [0–10.1]% FPR from 24 to 7 days after ROSC.…”

Section: Discussionmentioning

confidence: 99%

“…In two studies [84,115], the same low-ADC definition was used at three different timings from 3 h to day 7 after ROSC. Their results suggest [87] after ROSC. In one study mentioned above [85], "eye-balling" assessment of generalised oedema on brain CT predicted poor outcome with 56.5 [47-65.7]% sensitivity and 0 [0-10.1]% FPR from 24 to 7 days after ROSC.…”

Section: Imagingmentioning

confidence: 91%

“…Target temperature varied across studies (ESM Table E3). Fifteen studies [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] were included for clinical examination, 12 for biomarkers [37][38][39][40][41][42][43][44][45][46][47][48], 26 for electrophysiology , and 15 for imaging [75][76][77][78][79][80][81][82][83][84][85][86][87][88][89], while 26 studies were included for more than one prognostic modality.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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Purpose: To assess the ability of clinical examination, blood biomarkers, electrophysiology, or neuroimaging assessed within 7 days from return of spontaneous circulation (ROSC) to predict poor neurological outcome, defined as death, vegetative state, or severe disability (CPC 3-5) at hospital discharge/1 month or later, in comatose adult survivors from cardiac arrest (CA). Methods: PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews (January 2013-April 2020) were searched. Sensitivity and false-positive rate (FPR) for each predictor were calculated. Due to heterogeneities in recording times, predictor thresholds, and definition of some predictors, meta-analysis was not performed. Results: Ninety-four studies (30,200 patients) were included. Bilaterally absent pupillary or corneal reflexes after day 4 from ROSC, high blood values of neuron-specific enolase from 24 h after ROSC, absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) or unequivocal seizures on electroencephalogram (EEG) from the day of ROSC, EEG background suppression or burst-suppression from 24 h after ROSC, diffuse cerebral oedema on brain CT from 2 h after ROSC, or reduced diffusion on brain MRI at 2-5 days after ROSC had 0% FPR for poor outcome in most studies. Risk of bias assessed using the QUIPS tool was high for all predictors. Conclusion: In comatose resuscitated patients, clinical, biochemical, neurophysiological, and radiological tests have a potential to predict poor neurological outcome with no false-positive predictions within the first week after CA. Guidelines should consider the methodological concerns and limited sensitivity for individual modalities. (PROSPERO CRD42019141169

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Imagingmentioning

confidence: 91%

Section: Study Characteristicsmentioning

confidence: 99%

See 2 more Smart Citations

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

et al. 2020

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“…A stricter application of the 24-h time limit would presumably have reduced overall sensitivity of the algorithm. However, recent studies indicate improved performance of brain CT after 24 h [21,33,34]. NSE cut-off values were defined from the same TTM-study cohort [7].…”

Section: Discussionmentioning

confidence: 99%

Performance of a guideline-recommended algorithm for prognostication of poor neurological outcome after cardiac arrest

et al. 2020

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Purpose: To assess the performance of a 4-step algorithm for neurological prognostication after cardiac arrest recommended by the European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM). Methods: Retrospective descriptive analysis with data from the Target Temperature Management (TTM) Trial. Associations between predicted and actual neurological outcome were investigated for each step of the algorithm with results from clinical neurological examinations, neuroradiology (CT or MRI), neurophysiology (EEG and SSEP) and serum neuron-specific enolase. Patients examined with Glasgow Coma Scale Motor Score (GCS-M) on day 4 (72-96 h) post-arrest and available 6-month outcome were included. Poor outcome was defined as Cerebral Performance Category 3-5. Variations of the ERC/ESICM algorithm were explored within the same cohort. Results: The ERC/ESICM algorithm identified poor outcome patients with 38.7% sensitivity (95% CI 33.1-44.7) and 100% specificity (95% CI 98.8-100) in a cohort of 585 patients. An alternative cutoff for serum neuron-specific enolase, an alternative EEG-classification and variations of the GCS-M had minor effects on the sensitivity without causing false positive predictions. The highest overall sensitivity, 42.5% (95% CI 36.7-48.5), was achieved when prognosticating patients irrespective of GCS-M score, with 100% specificity (95% CI 98.8-100) remaining. Conclusion: The ERC/ESICM algorithm and all exploratory multimodal variations thereof investigated in this study predicted poor outcome without false positive predictions and with sensitivities 34.6-42.5%. Our results should be validated prospectively, preferably in patients where withdrawal of life-sustaining therapy is uncommon to exclude any confounding from self-fulfilling prophecies.

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European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

et al. 2021

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The European Resuscitation Council (ERC) and the European Society of Intensive Care Medicine (ESICM) have collaborated to produce these post-resuscitation care guidelines for adults, which are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. The topics covered include the post-cardiac arrest syndrome, diagnosis of cause of cardiac arrest, control of oxygenation and ventilation, coronary reperfusion, haemodynamic monitoring and management, control of seizures, temperature control, general intensive care management, prognostication, long-term outcome, rehabilitation and organ donation.

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The prognostic value of gray–white matter ratio on brain computed tomography in adult comatose cardiac arrest survivors

Cited by 36 publications

References 18 publications

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Prediction of poor neurological outcome in comatose survivors of cardiac arrest: a systematic review

Performance of a guideline-recommended algorithm for prognostication of poor neurological outcome after cardiac arrest

European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: post-resuscitation care

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