If a head CT shows loss of gray/white differentiation or other signs associated with anoxic injury, some physicians will then discontinue hypothermia treatment. Is this common practice? Are there ever good outcomes in cases such as this?

摘要

Per the American Academy of Neurology Practice Parameter published in 2006 regarding prognostication after cardiac arrest, there is insufficient evidence to use brain swelling or an inversed gray and white matter ratio measured in Hounsfield units on CT to predict poor outcomes in survivors of cardiac arrest (Wijdicks et al., 2006). This recommendation was based on a study published by Torbey et al. in 2000, which looked at inversed gray and white matter ratios on CT in 25 patients with return of spontaneous circulation (ROSC) after cardiac arrest. A ratio of less than 1.18 at the level of the basal ganglia was 100% predictive of death (Torbey et ah, 2000). A similar study was published in Korea in 2008, which found that a ratio of less than 1.22 was predictive of death and vegetative state with a specificity and positive predictive value of 100% but only a sensitivity of 63% and negative predictive value of 56% (Choi et al., 2008).