The prognostic value of the grey-to-white matter ratio in cardiac arrest patients treated with extracorporeal membrane oxygenation

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• 作者：Young Hwan Lee^a ; ^h ; ¹ ; Young Taeck Oh^a ; ^h ; ¹ ; Hee Cheol Ahn^a ; ^{gsemdr68@hallym.or.kr" class="auth_mail" title="E-mail the corresponding author} ; Hyoung Soo Kim^b ; ^{cskhs99@hallym.ac.kr" class="auth_mail" title="E-mail the corresponding author} ; Sang Jin Han^c ; Jae Jun Lee^d ; Tae Hun Lee^e ; Jeong Yeol Seo^e ; Dong Hyuk Shin^f ; Sang Ook Ha^a ; Sang O Park^g
• 关键词：Cardiac arrest ; Computed tomography ; Extracorporeal membrane oxygenation ; Prognosis
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：99
• 期：Complete
• 页码：50-55
• 全文大小：728 K

文摘

The grey-to-white matter ratio (GWR) is a reliable predictor of the neurological outcome of out-of-hospital cardiac arrest (OHCA). However, the reliability in patients receiving extracorporeal membrane oxygenation-assisted cardiopulmonary resuscitation (ECPR) remains unknown. We evaluated the utility of the GWR in predicting neurological outcomes in ECPR-treated patients.

Methods

This single-centre retrospective study was conducted from July 2009 to January 2014. Patients who received ECPR for OHCA were classified into two groups: Cerebral performance category(CPC) 1–2 was defined as good, CPC 3–5 as poor outcome. Four GWR (GWR-AV[average], GWR-CO[cortex], GWR-BG[basal ganglia], and GWR-SI [simplified])were evaluated and compared between the groups.

Results

Of 38 patients who received ECPR for OHCA, 30 patients were enrolled. Five (16.7%) had a good outcome and 25(83.3%) a poor outcome. All GWR were significantly higher in the good outcome group than in the poor outcome group. ROC curve analysis produced the following areas under the curve: GWR-AV = 0.920 (95% CI 0.761 to 0.987), GWR-BG = 0.872 (95%CI 0.699 to 0.965), GWR-CO = 0.952 (95% CI 0.806 to 0.997), and GWR-SI = 0.848(95% CI 0.670 to 0.962). The cut-off value with 100% specificity for the prediction of the poor outcome was 1.23 for GWR-AV (sensitivity: 76%), 1.24 for GWR-BG (sensitivity: 88.0%), 1.22 for GWR-CO (sensitivity: 64%), and 1.21 for GWR-SI (sensitivity: 76%).

Conclusions

In ECPR, GWR of patients with poor outcome was significantly lower than that of patients with good outcome.