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Early head CT in post-cardiac arrest patients: A helpful tool or contributor to self-fulfilling prophecy?

Rachel Beekman1, Carolina B Maciel2, Cora H Ormseth1

  • 1Department of Neurology, Yale School of Medicine, New Haven, CT, 06510, United States.

Resuscitation
|June 20, 2021
PubMed

Insights

Early head computed tomography (HCT) in cardiac arrest (CA) patients often changes management, particularly when hypoxic-ischemic brain injury (HIBI) is detected. However, interpretation discrepancies are common, impacting prognostication accuracy.

Area of Science:

  • Neurology
  • Radiology
  • Critical Care Medicine

Background:

  • Neuroprognostication guidelines suggest early head computed tomography (HCT) may aid in evaluating cardiac arrest (CA) survivors.
  • Early HCT can potentially inform clinical decision-making following return of spontaneous circulation.

Purpose of the Study:

  • To determine the impact of early HCT, performed within 6 hours post-CA, on patient management decisions.
  • To assess the utility of early HCT in identifying hypoxic-ischemic brain injury (HIBI) burden.

Main Methods:

  • Retrospective cohort study of unconscious post-CA patients (2012-2017).
  • Analysis of demographics, CA details, and post-CA care, including neuroimaging.
  • Adjudication of HCT findings by neurointensivists and calculation of gray-white matter ratio (GWR).

Main Results:

  • 182 of 302 patients (60.2%) underwent early HCT.
  • Abnormalities, primarily HIBI, were found in 25% of early HCTs, leading to management changes in nearly half of cases.
  • Radiographic HIBI correlated with lower GWR and higher progression to brain death; inter-rater reliability for HIBI interpretation was poor.

Conclusions:

  • Early HCT frequently influences therapeutic decisions in post-CA patients.
  • Significant discrepancies exist in HCT interpretation between radiology and neurointensivists, particularly regarding HIBI severity.
Abstract

Keywords:
Brain deathComputed tomographyHeart arrestHypoxic-ischemic encephalopathyNeuroimagingSelf-fulfilling prophecy

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