The association of findings on brain computed tomography with neurologic outcomes following extracorporeal cardiopulmonary resuscitation

Background: Limited data are available on imaging predictors of neurological outcomes after extracorporeal cardiopulmonary resuscitation (ECPR). We investigated the association of initial brain computed tomography (CT) findings with neurological outcomes following ECPR. Methods: Between February 2005 and December 2015, a total of 42 patients who underwent brain CT scans within 48 hours after ECPR were analyzed. Loss of the boundary between gray matter and white matter (LOB) or cortical sulcal effacement (SE), gray-to-white matter ratio (GWR), and optic nerve sheath diameter (ONSD) were measured on initial brain CT. The primary outcome was the Cerebral Performance Categories (CPC) scale at discharge. Conclusions: GWR, ONSD and LOB/SE on initial brain CT scans are associated with neurological prognosis in patients who underwent ECPR. A risk prediction model using a composite of GWR, ONCD, and LOB/SE could provide better information on neurologic outcomes in patients who underwent ECPR.

背景：目前关于体外心肺复苏（extracorporeal cardiopulmonary resuscitation, ECPR）后神经系统预后的影像学预测因子的相关研究资料较为匮乏。本研究旨在探讨体外心肺复苏术后早期脑部计算机断层扫描（computed tomography, CT）表现与患者神经系统预后的关联。方法：本研究纳入2005年2月至2015年12月期间，共42例于体外心肺复苏术后48小时内接受脑部CT扫描的患者进行回顾性分析。于初始脑部CT影像中测量脑灰白质分界消失（loss of the boundary between gray matter and white matter, LOB）或脑沟消失（cortical sulcal effacement, SE）、灰白质比值（gray-to-white matter ratio, GWR）以及视神经鞘直径（optic nerve sheath diameter, ONSD）。本研究的主要结局指标为患者出院时的脑性能分类量表（Cerebral Performance Categories, CPC）评分。结论：初始脑部CT影像中的灰白质比值（GWR）、视神经鞘直径（ONSD）以及脑灰白质分界消失/脑沟消失（LOB/SE）与接受体外心肺复苏术患者的神经系统预后显著相关。基于灰白质比值、视神经鞘直径及脑灰白质分界消失/脑沟消失构建的复合风险预测模型，可为体外心肺复苏术后患者的神经系统预后评估提供更具临床参考价值的信息。