Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management
Head computed tomography for prognostication of poor outcome in comatose patients after cardiac arrest and targeted temperature management
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DOI：
10.1016/j.resuscitation.2017.06.027
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发表时间：
2017-10-01
期刊：
影响因子：
6.5
通讯作者：
Cronberg, Tobias
中科院分区：
文献类型：
--
作者：
Moseby-Knappe, Marion;Pellis, Tommaso;Cronberg, Tobias
引言：推荐一种多模式方法来证实心脏骤停（CA）后的结局。联合使用各种方法的证据很少。在这项事后分析中，我们描述了CA后头部计算机断层扫描（CT）的结果。我们还研究了是否全身性水肿CT单独或与生物标志物神经元特异性烯醇化酶（NSE）可以预测不良outcome.Methods：患者参加目标温度管理后，院外心脏骤停试验进行CT的基础上的临床指征。根据当地放射科医生的描述，将结果分为预先指定的类别。全身性水肿单独和结合峰值NSE在48小时或72小时与不良结局在6个月随访使用脑功能分类（CPC 3-5）。结果：356/939（37.9%）的患者进行了头部CT。初始CT 38 ng/l和CT上的全身水肿预测不良结局，灵敏度为46.0%（95% CI：36.5-55.8），无假阳性。结论：在本研究中，全身性水肿多见于> 24 h
Introduction: A multimodal approach to prognostication of outcome after cardiac arrest (CA) is recommended. Evidence for combinations of methods is low. In this post-hoc analysis we described findings on head computed tomography (CT) after CA. We also examined whether generalised oedema on CT alone or together with the biomarker Neuron-specific enolase (NSE) could predict poor outcome.Methods: Patients participating in the Target Temperature Management after out-of-hospital-cardiac-arrest-trial underwent CT based on clinical indications. Findings were divided into pre-specified categories according to local radiologists descriptions. Generalised oedema alone and in combination with peak NSE at either 48 h or 72 h was correlated with poor outcome at 6 months follow-up using the Cerebral Performance Category (CPC 3-5).Results: 356/939 (37.9%) of patients underwent head CT. Initial CT 38 ng/l and generalised oedema on CT predicted poor outcome with 46.0% sensitivity (95% CI: 36.5-55.8) with no false positives. NSE was significantly higher in patients with generalised oedema.Conclusion: In this study, generalised oedema was more common > 24h