Abstract 301: Tc-99m ECD SPECT Brain Perfusion as a Novel Indicator Predicting Neurological Prognosis in Patients Resuscitated From Cardiac Arrest
Background: To date there are limited prognostic indicators that well predict the neurological outcomes in patients resuscitated from cardiac arrest. 99mTc-ethylcysteinate dimer (ECD) brain perfusion scan has been shown to implicate the viability of neurons. We therefore investigate the role of this novel indicator in predicting post-resuscitation neurological prognoses.
Methods: Post-cardiac arrest patients who remained unconsciousness after CPR were prospectively enrolled from Jan. 2010 to May 2013. Brain perfusion scan with 99mTc ECD SPECT were performed within 3-10 days post-CPR. All images were interpreted and scored independently by two nuclear medicine physicians blinded to the patients’ clinical information. Nine distinct regions of the brain were scored, including upper brain stem and bilateral thalamus, basal ganglia, cerebral cortex and cerebellum. The scores ranged from 0 (normal) to 4 (worst), and were correlated with all clinical factors and the neurological outcome of the patients.
Results: Ninety-one patients (64.1 ± 16.3 years old; 62 men) were enrolled during the study period. Fifty-nine survived to hospital discharge and 23 had neurological recovery with cerebral performance category (CPC) scale 1 or 2. Younger age, Vf/VT, shorter CPR time, lower epinephrine dose and therapeutic hypothermia were associated with good neurological recovery. For brain perfusion scan, the scores in all 9 areas were significantly lower in patients with good neurological recovery (all P < 0.05). Patients receiving therapeutic hypothermia (n=69) had better survival and neurological outcomes (both P < 0.05). The 99mTc ECD perfusion was significantly better in the upper brain stem and bilateral basal ganglia in these patients (all P < 0.05). In binary logistic regression analysis, the 99mTc ECD perfusion in the upper brain stem, together with age, Vf/VT and CPR time, served as independent prognostic factors for neurological recovery. The perfusion score of greater than 2 in the upper brain stem exclusively predicted a poor neurological prognosis.
Conclusions: 99mTc ECD brain perfusion may serve as a novel independent indicator for post-resuscitation neurological prognosis. Poor perfusion in upper brain stem predicts a poor neurological outcome.
- Cardiopulmonary resuscitation
- Post cardiac resuscitation
- Post cardiac arrest care
- Cerebrovascular circulation
- © 2013 by American Heart Association, Inc.