title: The prognostic value of the grey-to-white matter ratio in cardiac arrest patients treated with extracorporeal membrane oxygenation.
abstract: OBJECTIVE
  The grey-to-white matter ratio (GWR) is a reliable predictor of the neurological outcome of out-of-hospital cardiac arrest (OHCA). However, the reliability in patients receiving extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation (ECPR) remains unknown. We evaluated the utility of the GWR in predicting neurological outcomes in ECPR-treated patients.
  
  
  METHODS
  This single-centre retrospective study was conducted from July 2009 to January 2014. Patients who received ECPR for OHCA were classified into two groups: Cerebral performance category(CPC) 1-2 was defined as good, CPC 3-5 as poor outcome. Four GWR (GWR-AV[average], GWR-CO[cortex], GWR-BG[basal ganglia], and GWR-SI [simplified])were evaluated and compared between the groups.
  
  
  RESULTS
  Of 38 patients who received ECPR for OHCA, 30 patients were enrolled. Five (16.7%) had a good outcome and 25(83.3%) a poor outcome. All GWR were significantly higher in the good outcome group than in the poor outcome group. ROC curve analysis produced the following areas under the curve: GWR-AV=0.920 (95% CI 0.761 to 0.987), GWR-BG=0.872 (95%CI 0.699 to 0.965), GWR-CO=0.952 (95% CI 0.806 to 0.997), and GWR-SI=0.848(95% CI 0.670 to 0.962). The cut-off value with 100% specificity for the prediction of the poor outcome was 1.23 for GWR-AV (sensitivity: 76%), 1.24 for GWR-BG (sensitivity: 88.0%), 1.22 for GWR-CO (sensitivity: 64%), and 1.21 for GWR-SI (sensitivity: 76%).
  
  
  CONCLUSIONS
  In ECPR, GWR of patients with poor outcome was significantly lower than that of patients with good outcome.
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea; Department of emergency medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, Republic of Korea.
authors.forename: Young Hwan
authors.initials: YH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea; Department of emergency medicine, College of Medicine, Kangwon National University, Chuncheon, Gangwon 200-701, Republic of Korea.
authors.forename: Young Taeck
authors.initials: YT
authors.lastname: Oh
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea. Electronic address: gsemdr68@hallym.or.kr.
authors.forename: Hee Cheol
authors.initials: HC
authors.lastname: Ahn
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 200-704, Republic of Korea. Electronic address: cskhs99@hallym.ac.kr.
authors.forename: Hyoung Soo
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, 77 Sakju-ro, Chuncheon 200-704, Republic of Korea.
authors.forename: Sang Jin
authors.initials: SJ
authors.lastname: Han
authors.affiliation: Department of Anesthesiology, School of Medicine, Hallym University, Chuncheon, Republic of Korea.
authors.forename: Jae Jun
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Chuncheon, Republic of Korea.
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, School of Medicine, Hallym University, Chuncheon, Republic of Korea.
authors.forename: Jeong Yeol
authors.initials: JY
authors.lastname: Seo
authors.affiliation: Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Dong Hyuk
authors.initials: DH
authors.lastname: Shin
authors.affiliation: Department of Emergency Medicine, Hallym University Sacred Heart Hospital, Hallym University, Anyang-si, Gyeonggi-do, Republic of Korea.
authors.forename: Sang Ook
authors.initials: SO
authors.lastname: Ha
authors.affiliation: Department of Emergency Medicine, School of medicine, Konkuk University Konkuk University Medical Center, Seoul, Republic of Korea.
authors.forename: Sang O
authors.initials: SO
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D066127:White Matter / Q000000981:diagnostic imaging*
keywords: Cardiac arrest; Computed tomography; Extracorporeal membrane oxygenation; Prognosis