Marion Moseby-Knappe1, Tommaso Pellis2, Irina Dragancea3, Hans Friberg4, Niklas Nielsen5, Janneke Horn6, Michael Kuiper7, Andrea Roncarati8, Roger Siemund9, Johan Undén10, Tobias Cronberg3. 1. Lund University, Skane University Hospital, Department of Clinical Sciences, Division of Neurology, Lund, Sweden. Electronic address: marion.moseby@med.lu.se. 2. Department of Anaesthesia and Intensive Care, Azienda Ospedaliera G. Panico, Tricase, Italy. 3. Lund University, Skane University Hospital, Department of Clinical Sciences, Division of Neurology, Lund, Sweden. 4. Lund University, Skane University Hospital, Department of Clinical Sciences, Division of Anaesthesiology and Intensive Care, Lund, Sweden. 5. Lund University, Helsingborg Hospital, Department of Clinical Sciences, Division of Anaesthesiology and Intensive Care, Lund, Sweden. 6. Department of Intensive Care, Academic Medical Center, Amsterdam, Netherlands. 7. Department of Intensive Care, Medical Center Leeuwarden, Leeuwarden, Netherlands. 8. Department of Anesthesia, Intensive Care and Emergency Medical Service AAS 5, Santa Maria Degli Angeli Hospital, Pordenone, Italy. 9. Lund University, Skane University Hospital, Department of Clinical Sciences, Division of Neuroradiology, Lund, Sweden. 10. Lund University, Hallands Hospital Halmstad, Department of Anaestesia and Intensive Care, Halmstad, Sweden.
Abstract
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 48h or 72h 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≤24h after CA was normal in 174/218 (79.8%), whilst generalised oedema was diagnosed in 21/218 (9.6%). Between days 1-7, generalised oedema was seen in 65/143 (45.5%), acute/subacute infarction in 27/143 (18.9%) and bleeding in 9/143 (6.3%). Overall, generalised oedema predicted poor outcome with 33.6% sensitivity (95%CI:28.1-39.5) and 98.4% specificity (95%CI:94.3-99.6), whilst peak NSE demonstrated sensitivities of 61.5-64.8% and specificity 95.7% (95%CI:89.5-98.4). The combination of peak NSE>38ng/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≤7d after CA. The combination of CT and NSE improved sensitivity and specificity compared to CT alone, with no false positives in this limited population.
RCT Entities:
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 48h or 72h 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≤24h after CA was normal in 174/218 (79.8%), whilst generalised oedema was diagnosed in 21/218 (9.6%). Between days 1-7, generalised oedema was seen in 65/143 (45.5%), acute/subacute infarction in 27/143 (18.9%) and bleeding in 9/143 (6.3%). Overall, generalised oedema predicted poor outcome with 33.6% sensitivity (95%CI:28.1-39.5) and 98.4% specificity (95%CI:94.3-99.6), whilst peak NSE demonstrated sensitivities of 61.5-64.8% and specificity 95.7% (95%CI:89.5-98.4). The combination of peak NSE>38ng/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≤7d after CA. The combination of CT and NSE improved sensitivity and specificity compared to CT alone, with no false positives in this limited population.
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