Abstract 115: Early Head Computed Tomography Findings Are Associated With Outcomes After Pediatric Out-of-Hospital Cardiac Arrest
Findings of hypoxia ischemia on head computed tomography (HCT) after out of hospital cardiac arrest (OHCA) can be used to predict outcome. We hypothesize that loss of grey-white matter differentiation (GWM), basal cistern and sulcal effacement on early HCT after return of spontaneous circulation (ROSC) from pediatric OHCA will be associated with mortality and unfavorable neurologic outcome.
Children <18yo with OHCA who survived to ICU admission with a HCT within 1 day of ROSC. Patients with pre-arrest Pediatric Cerebral Performance Category (PCPC) >3 (pre-existing severe neurologic dysfunction) were excluded. HCTs were interpreted by a Pediatric Neuroradiologist for loss of GWM (Hounsfield units (HU) at 4 locations), sulcal and basal cistern effacement and reversal sign. Association of mortality and unfavorable neurologic function (discharge PCPC >3 or PCPC change ≥1 from baseline) with HCT findings were by Wilcoxon rank sum, Fisher’s exact test, PPV and NPV.
Seventy eight patients were evaluated. Median time to HCT from ROSC was 3.3 hours [1.0, 6.0]. Median age was 2.3 years [0.4, 9.5]. Fifty percent of patients survived, 74% with favorable neurologic outcome. Non-survivors had worse GWM differentiation than survivors (HU 0.96 [0.88, 1.07] v 1.1 [1.07, 1.2], p <0.001). Mortality was associated with basal cistern effacement (93% vs 7%, p=0.001, PPV 94%, NPV 59%), parenchymal hypodensity (86% v 14%, p <0.001, PPV 86%, NPV 63%), sulcal effacement and reversal sign (100% v 0%, p≤0.001, PPV 100%, NPV 68% & 57% respectively), but not intracranial hemorrhage (57% v 43%, p=0.5). All patients with loss GWM, sulcal effacement and reversal sign had unfavorable neurologic outcome. One patient with basal cistern effacement had favorable outcome.
Loss of grey-white matter differentiation, parenchymal hypodensity, basal cistern and sulcal effacement, and reversal sign are associated with poor outcome after pediatric OHCA. Select patients may have favorable outcomes despite these findings.
- © 2013 by American Heart Association, Inc.