Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients

PURPOSE: Assessment of prognosis after out-of-hospital cardiac arrest (OHCA) is challenging. Cerebral computed tomography (cCT) scans are widely available, but the use in prognostication of comatose OHCA-patients is unclear. We evaluated the prognostic value of cCT in a clinical cohort of OHCA-patients.

METHOD: A total of 1120 consecutive OHCA-patients with cardiac aetiology and successful or on-going resuscitation at hospital arrival were included (2002-2011). Utstein-criteria for registration of pre-hospital data and review of patient-charts for post-resuscitation care including cCT results were used. The primary endpoint was 30-day mortality analysed by log-rank and multivariate Cox-regression analyses.

RESULTS: A cCT scan was performed in 341(30%) of the clinical OHCA-cohort, and an early CT (<24h) was performed in 188 patients. The early CT was found 'normal' in 163(89%) and with reduced discrimination in 7(4%) of patients, which was independently associated with higher 30-day mortality compared with OHCA-patients with an early cCT (HRadjusted=3.5 (95%CI: 1.0-11.5), p=0.04). A late CT (≥24h) was performed in 153 patients in a median of 3 days (IQR: 2-5) and was 'normal' in 89(60%), 'cerebral bleeding' in 4(3%), 'new cerebral infarction' in 10(7%), and 'reduced discrimination between white and grey matter and/or oedema' in 45(30%) patients. 'Reduced discrimination and/or oedema' by late cCT was independently associated with higher 30-day mortality compared to patients with a normal late CT (HRadjusted=2.6 (95%CI: 1.4-4.8, p=0.002).

CONCLUSION: Our observations suggest that a cCT may be useful as part of the neurological prognostication in patients with OHCA. 'Reduced discrimination between white and grey matter and/or oedema' on cCT was independently associated with a poor prognosis.