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CT perfusion for Assessment of poor Neurological outcome in Comatose Cardiac Arrest Patients (CANCCAP): protocol for
Susan Alcock1, Sarbjeet Singh1, Evan J Wiens2
1Department of Radiology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
Insights
CT Perfusion (CTP) may predict brain injury in comatose cardiac arrest patients (CCAP). This study validates CTP for predicting poor neurological outcomes (mRS≥4) at hospital discharge in CCAP.
Area of Science:
- Neurology
- Radiology
- Emergency Medicine
Background:
- Cardiac arrest is a leading cause of death, with many survivors experiencing severe brain injury.
- Current neurological exams and CT scans have limitations in predicting early brain injury in comatose cardiac arrest patients (CCAP).
- CT Perfusion (CTP) shows promise for detecting brain abnormalities but its utility in CCAP is unexplored.
Purpose of the Study:
- To validate CT Perfusion (CTP) as a tool for predicting poor neurological outcomes in comatose cardiac arrest patients (CCAP).
- To assess the correlation between CTP findings and neurological status (modified Rankin Scale, mRS≥4) at hospital discharge.
Main Methods:
- Prospective cohort study enrolling 90 newly admitted CCAP undergoing standard Targeted Temperature Management.
- Patients receive a CTP scan concurrently with their standard head CT upon admission.
- CTP findings will be compared against bedside clinical assessments to determine predictive accuracy.
Main Results:
- Primary outcome is the prediction of poor neurological status (mRS≥4) versus good neurological status (mRS<4) at hospital discharge.
- The study aims to establish CTP's sensitivity and specificity in this patient population.
Conclusions:
- This study will determine if CTP can reliably predict neurological outcomes in CCAP.
- Findings may lead to improved prognostication and management strategies for cardiac arrest survivors.
Introduction:
Cardiac arrest remains one of the most common causes of death with the majority occurring outside of hospitals (out of hospital cardiac arrest). Despite advancements in resuscitation management, approximately 50% of comatose cardiac arrest patients (CCAP) will suffer a severe unsurvivable brain injury. To assess brain injury, a neurological examination is conducted, however, its reliability in predicting outcomes in the first days following cardiac arrest is limited. Non-contrast CT is the most employed scan to assess hypoxic changes, even though it is not sensitive to early hypoxic-ischaemic changes in the brain. CT perfusion (CTP) has shown high sensitivity and specificity in brain death patients, although its use in predicting poor neurological outcome in CCAP has not yet been explored. The purpose of this study is to validate CTP for predicting poor neurological outcome (modified Rankin scale, mRS≥4) at hospital discharge in CCAP.
Methods And Analysis:
The CT Perfusion for Assessment of poor Neurological outcome in Comatose Cardiac Arrest Patients study is a prospective cohort study funded by the Manitoba Medical Research Foundation. Newly admitted CCAP receiving standard Targeted Temperature Management are eligible. Patients undergo a CTP at the same time as the admission standard of care head CT. Admission CTP findings will be compared with the reference standard of an accepted bedside clinical assessment at the time of admission. Deferred consent will be used. The primary outcome is a binary outcome of good neurological status, defined as mRs<4 or poor neurological status (mRs≥4) at hospital discharge. A total of 90 patients will be enrolled.
Ethics And Dissemination:
This study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed at the end of the study.
Trial Registration Number:
NCT04323020.
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