Useful Computed Tomography Score for Estimation of Early Neurologic Outcome in Post-Cardiac Arrest Patients With Therapeutic Hypothermia

Abstract

Background:The Alberta Stroke Program Early CT Score (ASPECTS) is used to assess early ischemic stroke damage. This study compared bilateral ASPECTS (ASPECTS-b) with the gray:white matter ratio (GWR) and quantitative regional abnormality (QRA) to evaluate the prognostic utility of early computed tomography (CT) findings in post-cardiac arrest patients. Methods and Results:Out-of-hospital cardiac arrest patients with return of spontaneous circulation (ROSC) who underwent brain CT (<6 h after onset) and therapeutic hypothermia were recruited from a university hospital over a 2-year period. General demographics, ROSC characteristics, ASPECTS-b (total score=20 points), GWR, and QRA were assessed. Multivariate logistic regression analysis was used to predict neurologic outcome using cerebral performance category (CPC) at 1 month. The study population was divided into good (n=20; CPC 1-2) and poor (n=47; CPC 3-5) outcome groups. The good (vs. poor) outcome group was younger (mean [±SD] age 46.7±11.8 vs. 60.3±17.2 years; P=0.002) and had more initial shockable rhythms (40.0% vs. 8.5%; P=0.002). In addition, the good outcome group had a higher mean ASPECTS-b score (15.3±2.7 vs. 9.0±4.9; P<0.001), despite no differences in QRA and mean GWR. Age and ASPECTS-b were independent predictors of outcome after adjusting for potential confounders. Conclusions:These findings suggest that an initial CT score (ASPECTS-b) could help estimate early neurologic outcomes in postcardiac arrest patients treated with therapeutic hypothermia.

Impact of automated external defibrillator as a recent innovation for the resuscitation of cardiac arrest patients in an Urban City of Japan

“…The associations of a younger age, witnessed collapse, and ventricular fibrillation during prehospital CPR with a favorable outcome observed here have been reported in several previous studies[ 19 20 21 22 23 24 25 26 ] One reason for the inclusion of age as a factor is the decrease in the cerebral reserve function with age. [ 27 28 29 ] However, some reports on the neurologic outcome in successfully resuscitated elderly patients found that the outcome depended more on the cardiac arrest characteristics than the age.…”

Prognostic value of computed tomography score in patients after extracorporeal cardiopulmonary resuscitation

“…ASPECTS is a widely used screening tool to quantify the extent of ischemic hypodensity or hypoattenuation in ischemic stroke. ASPECTS and its modifications might be able to explain the quantitative association between cerebral insult following hypoxic-ischemic injury after cardiac arrest and neurological outcome [ 9 , 10 ]. In conventional CPR, ASPECT with some modifications could be used to estimate early neurologic outcomes in post-cardiac arrest patients [ 6 , 9 , 10 ].…”

“…Of original ASPECTSs for both hemispheres, the smaller value was used for analysis. To evaluate brain injuries in both hemispheres, bilateral ASPECTS (ASPECTS-b) was extended to both sides based on the original ASPECTS protocol [ 10 ]. In addition, modified ASPECTS (mASPECTS) was used in this study.…”

“…2 ) [ 6 ]. Whenever there were early ischemic findings on CT images such as parenchymal hypoattenuation, cortical swelling with sulcal effacement, and loss of gray-white matter differentiation from each area, new CT scores were calculated by subtracting 1 point from the maximum of 20 (ASPECTS-b) or 31 (mASPECTS) [ 6 , 10 ]. A brain with diffuse infarction that involved all areas was scored zero.…”

“…The Alberta Stroke Program Early Computed Tomography Score (ASPECTS) is a widely used screening tool that provides a framework for quantifying the extent of ischemic hypodensity or hypoattenuation in the middle cerebral arterial (MCA) territory [ 8 ]. In the setting of conventional cardiopulmonary resuscitation (CPR), ASPECTS with some modifications has been found to be useful to predict neurological outcomes of post-cardiac arrest patients [ 9 , 10 ]. However, whether ASPECTS might be helpful to systemically estimate neurological outcomes of survivors after extracorporeal cardiopulmonary resuscitation (ECPR) has not been reported.…”