Τίτλος:
Prognostication via early computed tomography head in patients treated with targeted temperature management after cardiac arrest
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Background: We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication. Methods: In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score—Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed. Results: Four of the neuroimaging variables—sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement—had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16–3.98, p = .015), poor disposition (OR 2.62, 95%CI 1.37–5.02, p = .004), in-hospital mortality (OR 1.99, 95%CI 1.09–3.62, p = .024), and ICU mortality (OR 1.89, 95%CI 1.12–3.20, p = .018). Conclusion: Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes. © 2019 Elsevier B.V.
Συγγραφείς:
Chang, J.J.
Tsivgoulis, G.
Goyal, N.
Alsherbini, K.
Schuring, C.
Shrestha, R.
Yankovich, A.
Metter, J.E.
Sareen, S.
Elijovich, L.
Malkoff, M.D.
Murillo, L.
Kadaria, D.
Alexandrov, A.V.
Sodhi, A.
Περιοδικό:
Journal of the Neurological Sciences
Λέξεις-κλειδιά:
adult; Article; basal ganglion; body mass; body temperature; brain edema; brain injury; cardiovascular mortality; clinical outcome; computer assisted tomography; controlled study; female; Glasgow coma scale; heart arrest; heart ventricle fibrillation; heart ventricle tachycardia; hospital mortality; human; induced hypothermia; intensive care unit; major clinical study; male; middle aged; neuroimaging; neuroprotection; out of hospital cardiac arrest; patient selection; predictive value; priority journal; prognosis; prognostic assessment; retrospective study; systolic blood pressure; targeted temperature management; white matter; aged; cohort analysis; diagnostic imaging; early diagnosis; induced hypothermia; mortality; out of hospital cardiac arrest; procedures; prospective study; treatment outcome; x-ray computed tomography, Aged; Cohort Studies; Early Diagnosis; Female; Hospital Mortality; Humans; Hypothermia, Induced; Male; Middle Aged; Out-of-Hospital Cardiac Arrest; Prognosis; Prospective Studies; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome
DOI:
10.1016/j.jns.2019.116437
