Prognostic value of computed tomography score in patients after extracorporeal cardiopulmonary resuscitation

Background: We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with some modifications could be used to predict neurological outcomes in patients after extracorporeal cardiopulmonary resuscitation (ECPR). Methods: This was a retrospective, multicenter, and observational study of adult unconscious patients who were evaluated by brain CT scan within 48 hours after ECPR between May 2010 and December 2016. ASPECTS, bilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by receiver operating characteristic curves to predict neurological outcomes. The primary outcome was neurological status upon hospital discharge assessed with Cerebral Performance Categories (CPC) scale. Results: Among 84 unconscious patients, survival to discharge was identified in 25 (29.8%) patients. Of these 25 survivors, 19 (22.6%) had good neurological outcomes (CPC score of 1 or 2). Inter-rater reliabilities of CT scores were excellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.927 (95% confidence interval [CI]: 0.889 to 0.952), 0.928 (95% CI: 0.891 – 0.953), and 0.928 (95% CI: 0.892 – 0.953), respectively. The predictive performance of mASPECTS for poor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS: 0.874 vs. 0.778, p = 0.008; mASPECTS vs. ASPECTS-b: 0.874 vs. 0.803, p = 0.011). On multivariable analysis, mASPECTS was an independent predictor for poor neurologic outcomes after ECPR (adjusted odds ratio: 0.78, 95% CI: 0.629 – 0.960). Conclusions: Modified ASPECTS might be useful for predicting neurological outcomes in patients after ECPR.