Background
Methods
Study population
Definitions and outcomes
Procedure
Statistical analyses
Results
Baseline characteristics
Good neurological outcome (n = 19) | Poor neurological outcome (n = 23) | Total (n = 42) |
p value | |
---|---|---|---|---|
Age, years (median (IQR)) | 41.0 (32.0–70.5) | 52.0 (43.0–60.5) | 51.0 (34.0–65.0) | 0.503 |
Gender, male (n (%)) | 14 (73.7) | 15 (65.2) | 29 (31.0) | 0.739 |
Body mass index (kg/m2) | 23.1 (21.1–25.7) | 24.1 (22.2–28.5) | 23.6 (21.5–26.7) | 0.105 |
Medical history (n (%)) | ||||
Diabetes mellitus | 1 (5.3) | 10 (43.5) | 11 (26.2) | 0.005 |
Hypertension | 3 (15.8) | 11 (47.8) | 14 (33.3) | 0.048 |
Malignancy | 3 (15.8) | 5 (21.7) | 8 (19.0) | 0.709 |
Smoking | 7 (36.8) | 11 (47.8) | 18 (42.9) | 0.474 |
Previous myocardial infarction | 0 (0) | 2 (8.7) | 2 (4.8) | 0.492 |
Initial Glasgow Coma Scale (median (IQR)) | 3 (3–6) | 3 (3–4) | 3 (3–5) | 0.518 |
Target temperature manage by surface cooling device (n (%)) | 7 (36.8) | 9 (39.1) | 16 (38.1) | 0.879 |
Interval between ECPR and CT scan (n (%)) | 0.001 | |||
0–6 h | 8 (42.1) | 11 (47.8) | 19 (45.2) | |
6–12 h | 0 (0) | 2 (8.7) | 2 (4.8) | |
12–24 h | 10 (52.6) | 1 (4.3) | 11 (26.2) | |
24–48 h | 1 (5.3) | 9 (39.1) | 10 (23.8) | |
Laboratory data on admission (median (IQR)) | ||||
Initial lactate (mg/dl) | 83.8 (51.4–127.0) | 105.4 (85.6–136.9) | 97.3 (68.5–132.4) | 0.133 |
(mmol/l) | 9.3 (5.7–14.1) | 11.7 (9.5–15.2) | 10.8 (7.6–14.7) | |
Hemoglobin before ECPR (g/dl) | 13.9 (10.5–15.6) | 12.0 (11.0–14.0) | 12.6 (10.9–14.6) | 0.263 |
(mmol/l) | 8.6 (6.5–9.7) | 7.4 (6.8–8.7) | 7.8 (6.8–9.1) | |
Hemoglobin after ECPR (g/dl) | 10.5 (8.8–11.9) | 9.9 (8.8–11.1) | 10.2 (8.8–11.5) | 0.597 |
(mmol/l) | 6.5 (5.5–7.4) | 6.1 (5.5–6.9) | 6.3 (5.5–7.1) | |
Total bilirubin (mg/dl) | 0.7 (0.5–1.2) | 1.0 (0.5–1.2) | 0.8 (0.5–1.2) | 0.744 |
(μmol/l) | 12.0 (8.6–20.5) | 17.1 (8.6–20.5) | 13.7 (8.6–20.5) | |
Blood urea nitrogen (mg/dl) | 16.7 (14.7–23.0) | 17.2 (13.6–21.8) | 16.7 (14.0–22.4) | 0.745 |
(mmol/l) | 6.0 (5.2–8.2) | 6.1 (4.9–7.8) | 6.0 (5.0–8.0) | |
Creatinine (mg/dl) | 1.2 (1.0–2.0) | 1.3 (1.1–1.7) | 1.3 (1.1–1.8) | 0.533 |
(μmol/l) | 106.1 (88.4–176.8) | 114.9 (97.2–150.3) | 114.9 (97.2–159.1) |
Good neurological outcome (n = 19) | Poor neurological outcome (n = 23) | Total (n = 42) |
p value | |
---|---|---|---|---|
Type of cardiac arrest (n (%)) | 0.999 | |||
Out-of-hospital cardiac arrest | 3 (15.8) | 4 (17.4) | 7 (16.7) | |
In-hospital cardiac arrest | 16 (84.2) | 19 (82.6) | 35 (83.3) | |
Bystander-witnessed cardiac arrest (n (%)) | 19 (100.0) | 23 (100.0) | 42 (100.0) | |
Bystander-performed CPR (n (%)) | 17 (89.5) | 23 (100.0) | 40 (95.2) | 0.199 |
First monitored rhythm (n (%)) | 0.714 | |||
Asystole | 2 (10.5) | 3 (13.0) | 5 (11.9) | |
Pulseless electrical activity | 8 (42.1) | 11 (47.8) | 19 (45.2) | |
Shockable rhythm (VT or VF) | 8 (42.1) | 9 (39.1) | 17 (40.5) | |
Defibrillation (n (%)) | 10 (55.6) | 13 (56.5) | 23 (56.1) | 0.951 |
ROSC before ECMO insertion (n (%)) | 8 (44.4) | 12 (52.2) | 20 (48.8) | 0.623 |
CPR to ECMO pump-on time, min (median (IQR)) | 43.5 (19.0–55.0) | 47.0 (33.5–56.0) | 45.0 (27.0–55.0) | 0.430 |
Location of ECMO insertion (n (%)) | 0.507 | |||
Intensive care unit | 6 (31.6) | 5 (21.7) | 11 (26.2) | |
Cath room | 3 (15.8) | 7 (30.4) | 10 (23.8) | |
Emergency room | 10 (52.6) | 10 (43.5) | 20 (47.6) | |
Operation room | 0 (0) | 1 (4.3) | 1 (2.4) | |
Cardiac cause of arrest (n (%)) | 17 (89.5) | 18 (78.3) | 35 (83.3) | 0.371 |
Acute coronary syndrome | 3 (15.8) | 7 (30.4) | 10 (23.8) | |
STEMI | 1 (5.3) | 3 (13.0) | 4 (9.5) | |
NSTEMI | 1 (5.3) | 3 (13.0) | 4 (9.5) | |
Unstable angina | 1 (5.3) | 1 (4.3) | 2 (4.8) | |
Cardiomyopathy | 1 (5.3) | 0 (0) | 1 (2.4) | |
Acute aortic syndrome | 0 (0) | 2 (8.7) | 2 (4.8) | |
Pulmonary thromboembolism | 3 (17.6) | 3 (13.0) | 6 (14.3) | |
Refractory arrhythmia | 5 (26.3) | 4 (17.4) | 9 (21.4) | |
Left ventricular wall rupture | 4 (21.1) | 1 (4.3) | 5 (11.9) | |
Other | 1 (5.3) | 1 (4.3) | 2 (4.8) |
Clinical and neurological outcomes
Brain CT findings
Good neurological outcome (n = 19) | Poor neurological outcome (n = 23) |
p value | |||
---|---|---|---|---|---|
Density of regions of interest, HU (median (IQR)) | |||||
Basal ganglia | Gray matter | CN | 34.90 (32.25–38.10) | 32.40 (28.20–35.60) | 0.071 |
PU | 35.70 (33.40–38.05) | 33.90 (31.25–35.9) | 0.129 | ||
White matter | CC | 27.90 (24.20–30.60) | 27.40 (25.55–29.75) | 0.752 | |
PIC | 27.70 (25.05–29.20) | 27.30 (26.15–28.80) | 0.950 | ||
Centrum semiovale (cortical) | Gray matter | MC1 | 31.90 (28.75–34.30) | 30.80 (27.65–32.45) | 0.306 |
White matter | MWM1 | 24.9 (22.25–29.55) | 25.30 (23.40–28.10) | 0.667 | |
High convexity area (cortical) | Gray matter | MC2 | 30.70 (28.85–33.80) | 29.70 (28.25–32.05) | 0.596 |
White matter | MWM2 | 24.60 (21.85–27.05) | 24.70 (22.00–27.45) | 0.527 | |
GWR (median (IQR)) | |||||
GWR-BG (basal ganglia) | 1.31 (1.25–1.37) | 1.21 (1.11–1.28) | 0.001 | ||
GWR-CO (cortical) | 1.23 (1.17–1.32) | 1.20 (1.09–1.29) | 0.098 | ||
GWR-SI (simplified) | 1.29 (1.25–1.38) | 1.21 (1.13–1.29) | 0.023 | ||
GWR-AV (average) | 1.29 (1.23–1.31) | 1.21 (1.10–1.26) | 0.007 | ||
Optic nerve sheath diameter, mm (median (IQR)) | 5.57 (5.14–5.98) | 6.07 (5.71–6.64) | 0.007 | ||
LOB at level of basal ganglia (n (%)) | 2 (10.5) | 15 (65.2) | <0.001 | ||
SE at level of centrum semiovale (n (%)) | 2 (10.5) | 15 (65.2) | <0.001 |
Discussion
Conclusions
Key messages
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Brain CT may be more helpful for predicting neurological outcome in ECPR patients under sedation because some clinical signs and examinations may also be confounded by sedation.
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GWR, ONSD, and LOB/SE on initial brain CT scans are associated with neurological outcome in patients who underwent ECPR.
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A composite of GWR, LOB/SE, and ONSD was a powerful predictor of neurological outcomes compared with each parameter alone. In real-world practice, combined CT parameters could provide improved information on early neurological prognosis in patients who underwent ECPR.