Combination of Cerebral Computed Tomography and Simplified Cardiac Arrest Hospital Prognosis (sCAHP) Score for Predicting Neurological Recovery in Cardiac Arrest Survivors

Abstract

Background: Cerebral computed tomography (CT) and various severity scoring systems have been developed for the early prediction of the neurological outcomes of cardiac arrest survivors. However, few studies have combined these approaches. Therefore, we evaluated the value of the combination of cerebral CT and severity score for neuroprognostication.

Methods: This single-center, retrospective observational study included consecutive patients surviving nontraumatic cardiac arrest (January 2016 and December 2020). Gray-to-white ratio (GWR), third and fourth ventricle characteristics, and medial temporal lobe atrophy scores were evaluated on noncontrast cerebral CT. Simplified cardiac arrest hospital prognosis (sCAHP) score was calculated for severity assessment. The associations between the CT characteristics, sCAHP score and neurological outcomes were analyzed.

Results: This study enrolled 559 patients. Of them, 194 (34.7%) were discharged with favorable neurological outcomes. Patients with favorable neurological outcome had a higher GWR (1.37 vs 1.25, p $<$ 0.001), area of fourth ventricle (461 vs 413 ${\mathrm{mm}}^2$ , p $<$ 0.001), anteroposterior diameter of fourth ventricle (0.95 vs 0.86 cm , p $<$ 0.001) and a lower sCAHP score (146 vs 190, p $<$ 0.001) than those with poor recovery. Patients with higher sCAHP score had lower GWR (p trend $<$ 0.001), area of fourth ventricle (p trend = 0.019) and anteroposterior diameter of fourth ventricle (p trend = 0.014). The predictive ability by using area under receiver operating characteristic curve (AUC) for the combination of sCAHP score and GWR was significantly higher than that calculated for sCAHP (0.86 vs 0.76, p $<$ 0.001) or GWR (0.86 vs 0.81, p = 0.001) alone.

Conclusions: The combination of GWR and sCAHP score can be used to effectively predict the neurological outcomes of cardiac arrest survivors and thus ensure timely intervention for those at high risk of poor recovery.

Keywords: cardiac arrest; cerebral CT; gray-to-white ratio; neuroprognostication; severity score.

Fig. 1.

Flowchart of patient enrollment. CPR, cardiopulmonary resuscitation; CT, computed tomography; ED, emergency department; ROSC, return of spontaneous circulation.

Fig. 2.

The predictive performance of GWR and severity score for poor neurological outcome. ROC, receiver operating characteristic; AUC, area under the receiver operating characteristic curve; GWR, gray-to-white ratio; sCAHP, simplified cardiac arrest hospital prognosis.