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Updated: Jan 19, 2026
Esophageal Heat Transfer for Patient Temperature Control and Targeted Temperature Management
Published on: November 21, 2017
Prognostication via early computed tomography head in patients treated with targeted temperature management after
Jason J Chang1, Georgios Tsivgoulis2, Nitin Goyal3
1Department of Neurology, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
Insights
Head CT scans before targeted temperature management (TTM) can predict outcomes in cardiac arrest patients. The Tennessee Early Neuroimaging Score (TENS) derived from these scans helps identify severe brain injury and poor prognoses.
Area of Science:
- Neurology
- Radiology
- Critical Care Medicine
Background:
- Cardiac arrest survivors often experience anoxic brain injury.
- Early prognostication is crucial for guiding post-arrest care.
- Computed tomography head (CTH) imaging is frequently obtained before targeted temperature management (TTM).
Purpose of the Study:
- To evaluate the utility of pre-TTM CTH imaging in predicting outcomes for cardiac arrest patients.
- To develop and validate a neuroimaging score for prognostication.
Main Methods:
- Retrospective cohort study of 341 adult out-of-hospital cardiac arrest patients.
- CTH variables were analyzed for association with outcomes.
- A composite neuroimaging score, the Tennessee Early Neuroimaging Score (TENS), was developed.
- Univariable and multivariable logistic regression analyses were performed.
Main Results:
- Four neuroimaging variables (sulcal, partial gray-white matter, total gray-white matter, and deep nuclei effacement) were significantly associated with outcomes.
- The TENS score was significantly associated with poor discharge CPC, poor disposition, in-hospital mortality, and ICU mortality.
- Multivariable models adjusted for confounders confirmed TENS's predictive value.
Conclusions:
- Pre-TTM CTH imaging can identify severe anoxic brain injury in post-cardiac arrest patients.
- The TENS score demonstrates utility in predicting poor neurological outcomes.
- Early neuroimaging may aid in clinical decision-making for cardiac arrest survivors.
Background:
We evaluated computed tomography head (CTH) imaging obtained prior to targeted temperature management (TTM) in patients after cardiac arrest, and its role in prognostication.
Methods:
In this retrospective cohort study in a tertiary-care hospital, 341 adults presenting with out-of-hospital cardiac arrest received a CTH prior to TTM. Associations between outcomes and neuroimaging variables were evaluated with Chi-square analysis for significant associations that yielded a composite neuroimaging score-Tennessee Early Neuroimaging Score (TENS). Univariable and multivariable logistic regression analysis including TENS as an independent variable and the four outcome dependent variables were analyzed.
Results:
Four of the neuroimaging variables-sulcal effacement, partial gray-white matter effacement, total gray-white matter effacement, deep nuclei effacement-had significant associations with each of the four outcome variables and yielded TENS. In multivariable logistic regression models adjusted for potential confounders, TENS was associated with poor discharge CPC (OR 2.15, 95%CI 1.16-3.98, p = .015), poor disposition (OR 2.62, 95%CI 1.37-5.02, p = .004), in-hospital mortality (OR 1.99, 95%CI 1.09-3.62, p = .024), and ICU mortality (OR 1.89, 95%CI 1.12-3.20, p = .018).
Conclusion:
Imaging prior to TTM may help identify post-cardiac arrest patients with severe anoxic brain injury and poor outcomes.
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