The role of Early Head CT following the OHCA survival: results based on patients enrolled in RIAC

Background: A multimodal approach is required to perform early neuro prognostication after cardiac arrest (CA). The objective of this study was to determinate the prognostic value of a positive early head computed tomography (EHCT) for anoxic-ischemic cerebral insult and its impact on 30-day survival rate. Methods: The retrospective study included all out-of-hospital cardiac arrest (OHCA) events, anonymously recorded with the Italian Registry of Cardiac Arrest (RIAC), occurred between January 1st, 2015 and December 31st, 2018 in which EHCT was performed within 2 hours upon ER arrival. Results: The characteristics of 156 patients were collected. 126 patients (81%) had an EHCT before admission to ICU, of these: n° 89 had a negative CT, n° 30 had a positive CT for anoxic-ischemic cerebral insult and n° 7 were excluded due to subarachnoid hemorrhage. Our data highlighted a positive association between EHCT and death, but specificity was 89% and sensitivity 38% meaning that the presence of brain injury was able to correctly predict 38% of the deaths and 89% of the positive outcomes. Conclusion: EHCT seems able to classify patients that will survive but tends to produce a high number of false negatives (62%). Therefore, in our cohort, it is insufficient in isolation to definitively prognosticate.