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Objective This study aimed to analyze intracranial vessels using brain computed tomography angiography (CTA) and scoring systems to diagnose brain death and predict poor neurologic outcomes of postcardiac arrest patients.
Methods Initial brain CTA images of postcardiac arrest patients were analyzed using scoring systems to determine a lack of opacification and diagnose brain death. The primary outcome was poor neurologic outcome, which was defined as cerebral performance category score 3 to 5. The frequency, sensitivity, specificity, positive predictive value, negative predictive value, and area under receiver operating characteristic curve for the lack of opacification of each vessel and for each scoring system used to predict poor neurologic outcomes were determined.
Results Patients with poor neurologic outcomes lacked opacification of the intracranial vessels, most commonly in the vein of Galen, both internal cerebral veins, and the mid cerebral artery (M4). The 7-score results (P=0.04) and 10-score results were significantly different (P=0.04) between outcome groups, with an area under receiver operating characteristic of 0.61 (range, 0.48 to 0.72). The lack of opacification of each intracranial vessel and all scoring systems exhibited high specificity (100%) and positive predictive values (100%) for predicting poor neurologic outcomes.
Conclusion Lack of opacification of vessels on brain CTA exhibited high specificity for predicting poor neurologic outcomes of patients after cardiac arrest.
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Prognostic value of machine learning for brain computed tomography as a predictor of neurologic outcomes after cardiac arrest: a systematic review and meta-analysis Kyung Hun Yoo, Juncheol Lee, Wonhee Kim, Bitnarae Kim, Elleah Jueun Chin, Jae-Guk Kim, Hyun-Young Choi, Jaehoon Oh Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine.2026;[Epub] CrossRef
Taking a New SLANT on Postcardiac Arrest Prognostication?* Neha S. Dangayach, Brian J. Wright Critical Care Medicine.2022; 50(3): 519. CrossRef
Objective Cerebral hemodynamic and metabolic changes may occur during the rewarming phase of targeted temperature management in post cardiac arrest patients. Yet, studies on different rewarming rates and patient outcomes are limited. This study aimed to investigate post cardiac arrest patients who were rewarmed with different rewarming rates after 24 hours of hypothermia and the association of these rates to the neurologic outcomes.
Methods This study retrospectively investigated post cardiac arrest patients treated with targeted temperature management and rewarmed with rewarming rates of 0.15°C/hr and 0.25°C/hr. The association of the rewarming rate with poor neurologic outcomes (cerebral performance category score, 3 to 5) was investigated.
Results A total of 71 patients were analyzed (0.15°C/hr, n=36; 0.25°C/hr, n=35). In the comparison between 0.15°C/hr and 0.25°C/hr, the poor neurologic outcome did not significantly differ (24 [66.7%] vs. 25 [71.4%], respectively; P=0.66). In the multivariate analysis, the rewarming rate of 0.15°C/hr was not associated with the 1-month neurologic outcome improvement (odds ratio, 0.54; 95% confidence interval, 0.16 to 1.69; P=0.28).
Conclusion The rewarming rates of 0.15°C/hr and 0.25°C/hr were not associated with the neurologic outcome difference in post cardiac arrest patients.
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Rewarming: The neglected phase of targeted temperature management Niklas Nielsen, Hans Kirkegaard Resuscitation.2020; 146: 249. CrossRef
High Quality Targeted Temperature Management (TTM) After Cardiac Arrest Fabio Silvio Taccone, Edoardo Picetti, Jean-Louis Vincent Critical Care.2020;[Epub] CrossRef
Resuscitating the Globally Ischemic Brain: TTM and Beyond Melika Hosseini, Robert H. Wilson, Christian Crouzet, Arya Amirhekmat, Kevin S. Wei, Yama Akbari Neurotherapeutics.2020; 17(2): 539. CrossRef
A practical approach to the use of targeted temperature management after cardiac arrest Filippo Annoni, Katia Donadello, Leda Nobile, Fabio S. Taccone Minerva Anestesiologica.2020;[Epub] CrossRef
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