Computed Tomography Perfusion Aids in the Prognostication of Comatose Postcardiac Arrest Patients

Jai Jai Shiva Shankar, Brandie Stewart-Perrin, Ata Ur Rehman Quraishi, Iqbal Bata, Robert Vandorpe

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20 Citations (Scopus)

Abstract

Early assessment of the potential for neurologic recovery in comatose cardiac arrest patients (CCAP) has been a challenge despite significant evolution in management and imaging techniques. The purpose of study was to determine if the use of computed tomography perfusion (CTP) in CCAPs is feasible and if this technique can predict the likelihood that CCAPs will have a devastating outcome at hospital discharge. We prospectively enrolled 10 newly admitted comatose adults who had an out-of-hospital cardiac arrest and were treated with standard therapeutic hypothermia protocols. Patients underwent CTP of the head within 6 hours after finishing therapeutic hypothermia treatment. The imaging findings were compared with the results of a clinical assessment, as well as the modified Rankin Scale (mRS) score at hospital discharge. Sensitivity, specificity, and positive and negative predictive values for CTP were calculated to predict clinical outcome. Eight patients had an mRS score of ≥5, and 2 patients had an mRS score of ≤2 at hospital discharge. CTP predicted a good clinical outcome in both patients with an mRS score of ≤2. The area under the curve (AUC) for plain computed tomography of the head, computerized tomography angiogram 4-point scale, computerized tomography angiogram 7-point scale, CTP of the whole brain, and CTP of the brainstem for predicting the results of the immediate clinical assessment were 0.76, 0.83, 0.67, 0.83, and 1.0, respectively. The AUCs for predicting outcome at discharge were 0.69, 0.63, 0.56, 0.63, 0.63, and 0.69, respectively. In conclusion, our pilot study showed that CTP is feasible and had a very high AUC for predicting the results of immediate clinical assessment in CCAP.

Original languageEnglish
Pages (from-to)874-878
Number of pages5
JournalAmerican Journal of Cardiology
Volume121
Issue number7
DOIs
Publication statusPublished - Apr 1 2018
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported by the Radiology Research Foundation at the Dalhousie University, Halifax.

Publisher Copyright:
© 2018 Elsevier Inc.

ASJC Scopus Subject Areas

  • Cardiology and Cardiovascular Medicine

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Shankar, J. J. S., Stewart-Perrin, B., Quraishi, A. U. R., Bata, I., & Vandorpe, R. (2018). Computed Tomography Perfusion Aids in the Prognostication of Comatose Postcardiac Arrest Patients. American Journal of Cardiology, 121(7), 874-878. https://doi.org/10.1016/j.amjcard.2017.12.027