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

Critical Care

Chi Ryang Chung¹  Kyeongman Jeon¹  Gee Young Suh¹  Jeong-Am Ryu¹  Jeong Hoon Yang¹  Minjung Kathy Chae²  Sei Hee Lee³  Young Hwan Lee⁴  Jeong-Ho Hong⁵  Hyoung Soo Kim⁶  Yang Hyun Cho⁷  Kiick Sung⁷  Taek Kyu Park⁸  Joo Myung Lee⁸ 

[1] Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine;Department of Emergency Medicine, Ajou University School of Medicine;Department of Emergency Medicine, Hallym University Medical Center;Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital;Department of Neurology, Keimyung University Dongsan Medical Center;Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center;Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine;Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine;

关键词: Brain computed tomography;    Cardiopulmonary resuscitation;    Extracorporeal membrane oxygenation;   

DOI  :  10.1186/s13054-018-2101-2

来源: DOAJ

【 摘 要 】

Abstract Background We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with some modifications could be used to predict neurological outcomes in patients after extracorporeal cardiopulmonary resuscitation (ECPR). Methods This was a retrospective, multicenter, observational study of adult unconscious patients who were evaluated by brain computed tomography (CT) within 48 hours after ECPR between May 2010 and December 2016. ASPECTS, bilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by ROC curves to predict neurological outcomes. The primary outcome was neurological status upon hospital discharge assessed with the Cerebral Performance Categories (CPC) scale. Results Among 58 unconscious patients, survival to discharge was identified in 25 (43.1%) patients. Of these 25 survivors, 19 (32.8%) had good neurological outcomes (CPC score of 1 or 2). Interrater reliability of CT scores was excellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.918 (95% CI, 0.865–0.950), 0.918 (95% CI, 0.866–0.951), and 0.915 (95% CI, 0.860–0.949), respectively. The predictive performance of mASPECTS for poor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS, 0.922 vs. 0.812, p = 0.004; mASPECTS vs. ASPECTS-b, 0.922 vs. 0.818, p = 0.003). A cutoff of 25 for poor neurological outcome had a sensitivity of 84.6% (95% CI, 69.5–94.1%) and a specificity of 89.5% (95% CI, 66.9–98.7%) in mASPECTS. Conclusions mASPECTS might be useful for predicting neurological outcomes in patients after ECPR.

【 授权许可】

Unknown