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.

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.