Resuscitation 85 (2014) 1309–1310
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Early CT imaging of the brain – A guide to therapy
While the post-cardiac arrest syndrome may affect multiple organ systems, neuronal injury is common and frequently severe.1 Failure to awaken following resuscitation from cardiac arrest is the most common reason for withdrawal of life sustaining treatment in the out-of-hospital cohort.2,3 A significant proportion of in-hospital cardiac arrest patients also die from neurologic injury.4 Determining patients who will awaken is challenging. Even prior to the advent of temperature management and standardized post arrest care, no single test or examination could rule out the possibility of a good outcome.5–8 Consequently, a multimodal approach is advocated9 to mitigate the self-fulfilling prophecy plaguing much of the prognostic literature. Potential tools in the postarrest population include: functional evaluation through clinical examination, electroencephalography and somatosensory evoked potentials; anatomic evaluation through neuroimaging; and blood markers of neuronal injury. Neuroimaging is an appealing modality that may be used to risk stratify the patient successfully resuscitated from cardiac arrest. Multiple studies report the association between neuroimaging and outcomes, but most are retrospective and provide limited information on how the study may have influenced clinical care.10 Brain computed tomography (CT) is especially appealing as it is rapid, available in many centers, and can identify alternative etiologies for the cardiac arrest. In this edition of Resuscitation, Cristia et al. refine a CT derivation of the gray/white matter ratio (GWR) in a post arrest population of 90 subjects receiving CT imaging within 24 h of ROSC.11 While prior work suggested a GWR < 1.2 reliably determined a population with poor outcome, this work demonstrated that a lower cut off (
Contents lists available at ScienceDirect
Resuscitation journal homepage: www.elsevier.com/locate/resuscitation
Editorial
Early CT imaging of the brain – A guide to therapy
While the post-cardiac arrest syndrome may affect multiple organ systems, neuronal injury is common and frequently severe.1 Failure to awaken following resuscitation from cardiac arrest is the most common reason for withdrawal of life sustaining treatment in the out-of-hospital cohort.2,3 A significant proportion of in-hospital cardiac arrest patients also die from neurologic injury.4 Determining patients who will awaken is challenging. Even prior to the advent of temperature management and standardized post arrest care, no single test or examination could rule out the possibility of a good outcome.5–8 Consequently, a multimodal approach is advocated9 to mitigate the self-fulfilling prophecy plaguing much of the prognostic literature. Potential tools in the postarrest population include: functional evaluation through clinical examination, electroencephalography and somatosensory evoked potentials; anatomic evaluation through neuroimaging; and blood markers of neuronal injury. Neuroimaging is an appealing modality that may be used to risk stratify the patient successfully resuscitated from cardiac arrest. Multiple studies report the association between neuroimaging and outcomes, but most are retrospective and provide limited information on how the study may have influenced clinical care.10 Brain computed tomography (CT) is especially appealing as it is rapid, available in many centers, and can identify alternative etiologies for the cardiac arrest. In this edition of Resuscitation, Cristia et al. refine a CT derivation of the gray/white matter ratio (GWR) in a post arrest population of 90 subjects receiving CT imaging within 24 h of ROSC.11 While prior work suggested a GWR < 1.2 reliably determined a population with poor outcome, this work demonstrated that a lower cut off (
