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Resuscitation. 2019 Jul;140:161-169. doi: 10.1016/j.resuscitation.2019.03.039. Epub 2019 Apr 3.

Grey-white matter ratio measured using early unenhanced brain computed tomography shows no correlation with neurological outcomes in patients undergoing targeted temperature management after cardiac arrest.

Author information

1
Department of Emergency Medicine, Chung-Ang University, College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea. Electronic address: emjyhong@gmail.com.
2
Department of Emergency Medicine, Chung-Ang University, College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea. Electronic address: emdhlee@cau.ac.kr.
3
Department of Emergency Medicine, Chung-Ang University, College of Medicine, 102, Heukseok-ro, Dongjak-gu, Seoul, Republic of Korea. Electronic address: jehyeokoh@cau.ac.kr.
4
Department of Emergency Medicine, Sanggye Paik Hospital, Inje University, Dongil-ro 1342, Nowon-gu, Seoul, Republic of Korea. Electronic address: sunhwa9@hanmail.net.
5
Emergency Medicine, Ewha Womans University, 1071, Anyangcheon-ro, Yangcheon-gu, Seoul, Republic of Korea. Electronic address: unii@ewha.ac.kr.
6
Department of Emergency Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, Republic of Korea. Electronic address: unidgirl@catholic.ac.kr.
7
Department of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of Korea. Electronic address: shiphid@hanmail.net.
8
Department of Emergency Medicine, College of Medicine, Korea University, Inchon-ro 73, Seongbuk-gu, Seoul, 02841, Republic of Korea. Electronic address: icarusksj@korea.ac.kr.
9
Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea. Electronic address: PYS0905@yuhs.ac.

Abstract

AIM:

This study evaluated whether the grey-white matter ratio (GWR) assessed via early brain computed tomography (CT) within 2 h after the return of spontaneous circulation (ROSC) following cardiac arrest is associated with poor neurological outcomes after 6 months in post-cardiac arrest patients treated with targeted temperature management (TTM).

METHODS:

This study used data from the Korean Hypothermia Network prospective registry obtained from November 2015 to October 2017 to assess patients with out-of-hospital cardiac arrest (OHCA) who underwent brain CT within 2 h following the ROSC. The primary endpoint was the neurological outcome 6 months post-cardiac arrest (cerebral performance category; CPC). The GWR was measured using early brain CT images. The subgroup analysis examined the difference in GWRs obtained from early and repeated brain CT.

RESULTS:

Five-hundred-twelve patients were enrolled. Good (CPC 1-2) and poor (CPC 3-5) neurological outcomes were observed in 162 (31.6%) and 350 (68.4%) patients, respectively. The multivariate logistic regression analysis revealed that the GWR measured using early brain CT was a statistically nonsignificant predictor of poor neurologic outcomes (p = 0.727). In patients with poor outcomes, the mean GWR obtained from early and repeated CT images were 1.171 ± 0.058 and 1.091 ± 0.133, respectively (p < 0.001); there was no statistically significant difference between the GWRs in patients with good outcomes.

CONCLUSION:

The GWR assessed via early brain CT alone is not an independent factor predictive of poor neurologic outcomes but could be useful when used with repeated CT data.

KEYWORDS:

Cardiac arrest; Grey–white matter ratio; Neurological outcome; Post-cardiac arrest syndrome; Prognostic factor; Targeted temperature management

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