Neurological prognostication tools in out-of-hospital cardiac arrest patients in Danish intensive care units from 2005 to 2013.
BACKGROUND
Neurological prognostication is an essential part of post-resuscitation care in out-of-hospital cardiac arrest (OHCA). This study aims to assess the use of computed tomography (CT) and magnetic resonance imaging (MR) of the head, electroencephalography (EEG), and somatosensory evoked potentials (SSEP) in neurological prognostication in resuscitated OHCA patients and factors associated with their use in Danish tertiary and non-tertiary centers from 2005 to 2013 and associations with outcome.


METHODS
We used the Danish Cardiac Arrest Registry to identify patients ≥18 years of age admitted to intensive care units due to OHCA of presumed cardiac etiology. CT 0-20 days and MR, SSEP, and EEG ≥2-20 days post OHCA were considered related to prognostication. Incidence and factors associated with procedures were assessed by multiple Cox regression with death as competing risk.


RESULTS
Use of CT, MR, EEG, and SSEP increased during the study period (CT: 51%-67%, HRCT : 1.06, CI: 1.03-1.08, MR: 2%-5%, P = .08, EEG: 6%-33%, HREEG : 1.25, CI: 1.19-1.30, SSEP: 4%-15%, HRSSEP : 1.23, CI: 1.15-1.32). EEG and SSEP were more used in tertiary centers than non-tertiary (HREEG : 1.86, CI: 1.51-2.29, HRSSEP : 4.44, CI: 2.86-6.89). Use of CT, SSEP, and EEG were associated with higher 30-day mortality, and MR was associated with lower (HRCT : 1.15, CI: 1.01-1.30, HRMR : 0.53, CI: 0.37-0.77, HRSSEP : 1.90, CI: 1.57-2.32, HREEG : 1.75, CI: 1.49-2.05).


CONCLUSION
Use of neurological prognostication procedures increased during the study period. EEG and SSEP were more used in tertiary centers. CT, EEG and SSEP were associated with increased mortality.
['Winther-Jensen|M|M|0000-0002-4447-6292', 'Hassager|C|C|', 'Lassen|J F|JF|', 'Køber|L|L|', 'Torp-Pedersen|C|C|', 'Hansen|S M|SM|', 'Lippert|F|F|', 'Kragholm|K|K|', 'Christensen|E F|EF|', 'Kjaergaard|J|J|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D015982:Bias D004569:Electroencephalography D005073:Evoked Potentials, Somatosensory D005260:Female D006801:Humans D007362:Intensive Care Units D008297:Male D008875:Middle Aged D058687:Out-of-Hospital Cardiac Arrest D011379:Prognosis D016016:Proportional Hazards Models D013997:Time Factors D014057:Tomography, X-Ray Computed
Neurological prognostication Out-of-hospital cardiac arrest CT MR EEG SSEP