The prognostic performance of brain ventricular characteristic differ according to sex, age, and time after cardiac arrest in comatose out-of-hospital cardiac arrest survivors

Abstract

Aim: We tested the consistency of ventricular characteristics measurement on brain computed tomography (CT) and investigated the prognostic performance of ventricular characteristics by sex, age, and time of brain CT in out-of-hospital cardiac arrest (OHCA) survivors.

Methods: We conducted a retrospective study of adult comatose OHCA survivors who underwent targeted temperature management and brain CT within 24 h after cardiac arrest (CA) between January 2010 and December 2018. We calculated gray-to-white matter ratio (GWR) of Hounsfield units, ventricular area (lateral, third, and fourth), and ventricular diameter (third and fourth). We divided time of brain CT after CA into three epochs: ≤2 h, 2-6 h, and 6-24 h. Male and female group was divided into two groups with cutoff of 50 and 60 years, respectively. The primary outcome was in-hospital mortality.

Results: Of 902 included patients, 218 (24.2%) survived to discharge. Ventricular characteristics had intra-class correlation coefficient (ICC) of 0.886-0.991, while GWR had an ICC (0.842). Area and diameter of fourth ventricle had significant prognostic performance in the whole group. Ventricular characteristics at 6-24 h had significant prognostic performance, while all ventricular characteristics had no significant performance at ≤2 h. Ventricular characteristics had significant prognostic performance in young male and female sub-groups, whereas not all ventricular characteristics had significant prognostic performance in old sub-groups.

Conclusions: The measurement of ventricular characteristics on brain CT was consistent in OHCA survivors. The prognostic performance of ventricular characteristics was best for brain CT 6-24 h after CA and differed according to age and sex sub-groups.

Keywords: Brain; Heart arrest; Oedema; Prognosis.