title: Prognostic value of reduced discrimination and oedema on cerebral computed tomography in a daily clinical cohort of out-of-hospital cardiac arrest patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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 (HR(adjusted) = 3.5 (95%CI: 1.0-11.5), p = 0.04). A late CT (≥ 24 h) 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 (HR(adjusted) = 2.6 (95%CI: 1.4-4.8, p = 0.002).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Sandra
authors.initials: S
authors.lastname: Langkjær
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Hassager
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Kjaergaard
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Idrees
authors.initials: I
authors.lastname: Salam
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Jakob Hartvig
authors.initials: JH
authors.lastname: Thomsen
authors.affiliation: Emergency Medical Services, Copenhagen, The Capital Region of Denmark, Denmark.
authors.forename: Freddy K
authors.initials: FK
authors.lastname: Lippert
authors.affiliation: Department of Cardiothoracic Anaesthesiology 4142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Michael
authors.initials: M
authors.lastname: Wanscher
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Køber
authors.affiliation: Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
authors.forename: Niklas
authors.initials: N
authors.lastname: Nielsen
authors.affiliation: Department of Cardiology 2142, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. Electronic address: helle.soholm@gmail.com.
authors.forename: Helle
authors.initials: H
authors.lastname: Søholm
mesh_terms: D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003718:Denmark / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D015996:Survival Rate / Q000639:trends; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Cerebral computed tomography (CT); Mortality; Out-of-hospital cardiac arrest (OHCA); Prognosis; Prognostication