Clin Exp Emerg Med.  2019 Dec;6(4):297-302. 10.15441/ceem.18.062.

Brain computed tomography angiography in postcardiac arrest patients and neurologic outcome

• An J
• Cho E
• Park E
• Lee SE
• Han M
• Min YG
• Chae MK

• KMID: 2469086
• DOI: http://doi.org/10.15441/ceem.18.062

Abstract

OBJECTIVE
This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.
METHODS
Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.
RESULTS
Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.
CONCLUSION
Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.

Keyword

Heart arrest; Hypothermia; Brain; Computed tomography angiography

MeSH Terms

Angiography*
Brain Death
Brain*
Cerebral Arteries
Cerebral Veins
Heart Arrest
Humans
Hypothermia
ROC Curve
Sensitivity and Specificity