scholarly journals Neurologic Prognostication by QEEG in Post Cardiac Arrest Patients with Therapeutic Hypothermia

2020 ◽  
Vol 38 (4) ◽  
pp. 260-271
Author(s):  
Sue Hyun Lee ◽  
Hyung Seok Ahn ◽  
Yong Hwan Kim ◽  
Hyang Woon Lee ◽  
Jung Hwa Lee
Keyword(s):  
Cardiac Arrest ◽  
Therapeutic Hypothermia ◽  
Brain Regions ◽  
Critical Conditions ◽  
Relative Power ◽  
Good Outcome ◽  
Poor Outcome ◽  
Neurologic Outcomes ◽  
Poor Outcome Group ◽  
Outcome Group

Background: Post-cardiac arrest syndrome (PCAS) is one of the critical conditions which can result in a more serious brain injury. Early and accurate prognostication is crucial for deciding the patient’s therapeutic plan and setting the treatment goal. This study aimed to establish the prognostication values of quantitative electroencephalography (QEEG) in PCAS patients.Methods: We recruited 183 PCAS patients treated with therapeutic hypothermia. Electroencephalography (EEG) data within 72 hours after cardiac arrest (CA) and clinical data were collected. QEEG analysis including power spectral density (PSD) and connectivity analysis of default mode network (DMN) with imaginary coherence were performed.Results: There were significantly different patterns of PSD between neurologic good and poor outcome groups; absolute and relative power of the alpha 2 and beta 1 frequency (10-15 Hz) bands were increased in all brain regions of good outcome group. However, the relative power of the delta band and higher frequency bands over fast alpha (beta 3 and gamma bands over 20 Hz) were poor outcome markers. We found out that connectivity of DMN were significantly decreased in the poor outcome group compared with the good outcome group.Conclusions: These findings suggest that QEEG analysis could quantify and automate the interpretation of EEG. Furthermore, they can improve the prognostic values for neurologic outcomes relatively accurately and objectively in PCAS patients treated with hypothermia compared with traditional visual grading.

Abstract 9720: A New Window on a Cerebral Penumbra at Risk for a Secondary Ischemic Brain Injury in Post-Cardiac Arrest Patients

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Changshin Kang ◽  
Jung Soo Park ◽  
Yeonho You
Keyword(s):  
Cardiac Arrest ◽  
Brain Injury ◽  
Ischemic Brain Injury ◽  
Ischemic Brain ◽  
Neurological Outcomes ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Aim: This study aimed to investigate new target having potential neuroprotective effect against a secondary ischemic brain injury in post out-of-hospital cardiac arrest (OHCA) patients. Methods: This study analyzed physiological variables among OHCA patients with good or poor neurological outcomes despite having normal diffusion-weighted image findings before targeted temperature management (TTM). The factors affecting cerebral perfusion after OHCA, such as the time-weighted average (TWA) of arterial carbon dioxide (PaCO 2 ), oxygen (PaO 2 ), and mean arterial pressure (MAP); and the intracranial pressure (ICP) and quotient albumin ratio (Qalb), measured at 0 and 24 h from the return of spontaneous circulation (ROSC), were analyzed retrospectively using prospectively collected data. The primary outcome was the association between the factors and poor neurological outcome. Results: Fifty-one patients were included in this study. Among them, 11 had poor neurological outcomes. The pre-hospital factors such as anoxic time, initial rhythm; and TWA of physiological factors (PaCO 2 , PaO 2 , and MAP), were not significantly different between groups (p > 0.05). The inter-group comparisons of Qalb at 0 and 24 h were not significant (p > 0.05), whereas Qalb (median [interquartile range]) significantly increased from 0 to 24 h in the poor outcome group (0.007 [0.003 - 0.011] to 0.013 [0.005 - 0.029]; p = 0.04). Simultaneously, the ICP of the poor outcome group significantly increased over time (12.0 mmHg [8.1 - 13.0] to 16.0 mmHg [9.3 - 22.4]; p = 0.03), and higher than those of good outcome group at 24 h (11.0 mmHg [6.5 - 16.0] vs. 16.0 [9.3 - 22.4]; p < 0.01). Conclusion: Blood-brain barrier disruption and increasing ICP were apparent in OHCA patients who progressed into poor outcome despite no significant difference of brain injury before TTM compared with those of good outcome. These factors may be the key window on strategy to prevent the secondary ischemic brain injury after OHCA.

scholarly journals Comparison of Prognostic Performance between Neuron-Specific Enolase and S100 Calcium-Binding Protein B Obtained from the Cerebrospinal Fluid of Out-Of-Hospital Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

2021 ◽  
Vol 10 (7) ◽  
pp. 1531
Author(s):  
Changshin Kang ◽  
Wonjoon Jeong ◽  
Jung Soo Park ◽  
Yeonho You ◽  
Jin Hong Min ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Cardiac Arrest ◽  
Calcium Binding ◽  
Neuron Specific Enolase ◽  
Poor Outcome ◽  
The Poor ◽  
S100 Calcium Binding Protein ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Hospital Cardiac Arrest

We compared the prognostic performances of serum neuron-specific enolase (sNSE), cerebrospinal fluid (CSF) NSE (cNSE), and CSF S100 calcium-binding protein B (cS100B) in out-of-hospital cardiac arrest (OHCA) survivors. This prospective observational study enrolled 45 patients. All samples were obtained immediately and at 24 h intervals until 72 h after the return of spontaneous circulation. The inter- and intragroup differences in biomarker levels, categorized by 3 month neurological outcome, were analyzed. The prognostic performances were evaluated with receiver operating characteristic curves. Twenty-two patients (48.9%) showed poor outcome. At all-time points, sNSE, cNSE, and cS100B were significantly higher in the poor outcome group than in the good outcome group. cNSE and cS100B significantly increased over time (baseline vs. 24, 48, and 72 h) in the poor outcome group than in the good outcome group. sNSE at 24, 48, and 72 h showed significantly lower sensitivity than cNSE or cS100B. The sensitivities associated with 0 false-positive rate (FPR) for cNSE and cS100B were 66.6% vs. 45.5% at baseline, 80.0% vs. 80.0% at 24 h, 84.2% vs. 94.7% at 48 h, and 88.2% (FPR, 5.0%) vs. 94.1% at 72 h. High cNSE and cS100B are strong predictors of poor neurological outcome in OHCA survivors. Multicenter prospective studies may determine the generalizability of these results.

Abstract TP195: Pre-Stroke Cognitive Impairment is Associated With Poor Outcome in Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Takuya Kanamaru ◽  
Satoshi Suda ◽  
Junya Aoki ◽  
Kentaro Suzuki ◽  
Yuki Sakamoto ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cognitive Impairment ◽  
Acute Ischemic Stroke ◽  
Mechanical Thrombectomy ◽  
Modified Rankin Scale ◽  
Good Outcome ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Significant Difference

Background: It is reported that pre-stroke cognitive impairment is associated with poor functional outcome after stroke associated with small vessel disease. However, it is not clear that pre-stroke cognitive impairment is associated with poor outcome in patients treated with mechanical thrombectomy. Method: We enrolled 127 consecutive patients treated with mechanical thrombectomy for acute ischemic stroke from December 2016 to November 2018. Pre-stroke cognitive function was evaluated using the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). We retrospectively compared poor outcome (a score of 3 to 6 on the modified Rankin Scale at 90 days) group (n=75) with good outcome (a score of 0, 1, or 2 on the modified Rankin Scale at 90 days) group (n=52) and examined that IQCODE could be the predictor of PO. Result: IQCODE was significantly higher in poor outcome group than in good outcome group (89 vs. 82, P=0.0012). Moreover, age (77.2 years old vs. 71.6 years old, P= 0.0009), the percentage of female (42.7% vs. 17.3%, P= 0.0021), complication of hypertension (HT, 68.0% vs. 44.2%, P=0.0076), National Institutes of Health Stroke Scale (NIHSS) at admission (20 vs. 11, P<0.0001), the percentage of postoperative intracerebral hemorrhage (ICH, 33.3% vs. 15.4%, P=0.0233) were higher in poor outcome group than in good outcome group, too. However, there was no significant difference between poor outcome and good outcome groups in occlusion site (P= 0.1229), DWI-ASPECTS (P= 0.2839), the duration from onset to recanalization (P=0.4871) and other risk factors. Multivariable logistic regression analysis demonstrated that IQCODE, HT and NIHSS at admission were associated with poor outcome (P= 0.0128, P=0.0061 and P<0.0001, respectively). Conclusion: Cognitive impairment could be associated with poor outcome in patients treated with mechanical thrombectomy.

Abstract 307: The Value of Intracranial Pressure Measurement via Lumbar Puncture as an Early Prognostic Predictor in Cardiac Arrest Patients Treated With Targeted Temperature Management

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Yeonho You ◽  
Jung Soo Park ◽  
Jin Hong Min
Keyword(s):  
Cardiac Arrest ◽  
Lumbar Puncture ◽  
Brain Injuries ◽  
Roc Curves ◽  
Neurologic Outcome ◽  
Temperature Management ◽  
Significance Level ◽  
Poor Outcome ◽  
Neurologic Outcomes ◽  
Outcome Group

Introduction: We evaluated prognostic value of ICP measurement via lumbar puncture to predict outcome of cardiac arrest patients treated with TTM Methods: This was a single-center observational cohort study using paper sheets of patients from October 2012 to June 2017. The primary endpoint was the ability of the early ICP measurement to predict poor outcome within 24 h after cardiac arrest, compared to ONSD and GWR. Based on previous studies, 32 patients were needed to achieve the power of 0.90 at a significance level of 0.05. The ROC curves was used to compare the values of ONSD, GWR and ICP for predicting neurologic outcomes. Results were considered significant at P < 0.05. Results: 103 patients were enrolled and good outcome group had 31 patients, while poor outcome group had 72 patients. The AUROC of ONSD and GWR were 0.64(0.54-0.73) and 0.63 (0.53-0.72) respectively in predicting poor neurologic outcome while the AUROC of ICP was 0.97(0.92-0.99) in predicting poor neurologic outcome (Fig. 2). As the cut off value of ICP was 200 mmH 2 O, sensitivity was 87.50% and specificity was 100.00% in predicting poor neurologic outcome. In ONSD, sensitivity was 78.43% and specificity was 41.86% in predicting poor neurologic outcome when cut off value was 5.50 mm. As the cut off value of GWR was 1.16, sensitivity was 59.72% and specificity was 74.19% in predicting poor neurologic outcome. Conclusion: In this study, we confirms that ICP measurement via lumbar puncture within the first 24 h after cardiac arrest is a valuable tool to evaluate the severity of post-cardiac arrest brain injuries and outcome in patients treated with TTM.

Abstract WP58: Correlating Stroke Volume with National Institute of Health Stroke Scale as a Means of Determining Patient Prognosis

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pamela J Zelnick ◽  
Liang Zhu ◽  
Louise D McCullough ◽  
Amrou Sarraj
Keyword(s):  
Patient Outcomes ◽  
Infarct Volume ◽  
Strong Predictor ◽  
Ratio Test ◽  
Vessel Occlusion ◽  
Good Outcome ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group

Introduction: The NIH Stroke Scale (SS) is a widely used tool for directing treatment and predicting outcomes in Acute Ischemic Stroke (AIS). Severe strokes with high admission SS often correlate with long term disability, and as such, SS serves as a strong predictor of outcome. Final infarct volume (FIV) is also a pivotal predictor of stroke outcome. We aimed to evaluate the relationship between SS, FIV and outcome, and hypothesize that a combined approach evaluating both FIV and SS may more accurately correlate with patient outcomes. Methods: A single center, retrospective cohort study, examined AIS patients with large vessel occlusion (LVO) affecting the anterior circulation, between July 2004 and April 2013. Patients were stratified by treatment to 1) intra-arterial therapy, 2) IV tPA, 3) both or 4) neither. Primary outcomes measured were mRS at discharge and 90 days (good outcome mRS 0-2, poor 4-6). FIV was manually calculated from DWI obtained within the first 7 days of presentation. SS and FIV were compared against good and poor mRS outcomes using Wilcoxon rank sum test. Logistic regression analysis was used to evaluate the association between SS, FIV and mRS. Finally, likelihood ratio test was used to compare model fit between a model including SS alone and model including both SS and FIV. Results: In 332 patients, SS was significantly higher in the poor outcome group (17.3 ± 5.4) when compared to the good outcome group (13.0 ± 6.1) (p=0.0002). In the same analysis, FIVs were also larger in the poor outcome group (110.3 ± 113 cm3) when compared to the good outcome group (37.2 ± 68.3 cm3) (p<0.0001). A combined SS and FIV model correlated significantly better with discharge outcome than did SS alone (p=0.0015). Analysis of 182 patient outcomes at 90 days maintained similar findings, with SS (18 ± 5.9) and FIVs (115.4 ± 121.0 cm3) significantly higher in poor outcomes than in good outcomes; (13.0 ± 5.4) and (35.7 ± 38.2 cm3) respectively (p<0.0001). Combined SS and FIV model, again, was significantly better at modeling outcome at 90 days than was a model including SS alone (p=0.0044). Conclusions: A combined model including FIV and SS better correlates with clinical outcomes at discharge and 90 days in patients with AIS due to LVO, than does a model using SS alone.

Higher Baseline Cortical Score Predicts Good Outcome in Patients With Low Alberta Stroke Program Early Computed Tomography Score Treated with Endovascular Treatment

Neurosurgery ◽  
2020 ◽  
Author(s):  
Peng-fei Xing ◽  
Yong-wei Zhang ◽  
Lei Zhang ◽  
Zi-fu Li ◽  
Hong-jian Shen ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Endovascular Treatment ◽  
Receiver Operating Characteristics ◽  
Operating Characteristics ◽  
Good Outcome ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Receiver Operating Characteristics Curve ◽  
Receiver Operating

Abstract BACKGROUND Patients with large vessel occlusion and noncontrast computed tomography (CT) Alberta Stroke Program Early CT Score (ASPECTS) &lt;6 may benefit from endovascular treatment (EVT). There is uncertainty about who will benefit from it. OBJECTIVE To explore the predicting factors for good outcome in patients with ASPECTS &lt;6 treated with EVT. METHODS We retrospectively reviewed 60 patients with ASPECTS &lt;6 treated with EVT in our center between March 2018 and June 2019. Patients were divided into 2 groups because of the modified Rankin Score (mRS) at 90 d: good outcome group (mRS 0-2) and poor outcome group (mRS ≥3). Baseline and procedural characteristics were collected for unilateral variate and multivariate regression analyses to explore the influent variates for good outcome. RESULTS Good outcome (mRS 0-2) was achieved in 24 (40%) patients after EVT and mortality was 20% for 90 d. Compared with the poor outcome group, higher baseline cortical ASPECTS (c-ASPECTS), lower intracranial hemorrhage, and malignant brain edema after thrombectomy were noted in the good outcome group (all P &lt; .01). Multivariate logistic regression showed that only baseline c-ASPECTS (≥3) was positive factor for good outcome (odds ratio = 4.29; 95% CI, 1.21-15.20; P = .024). The receiver operating characteristics curve indicated a moderate value of c-ASPECTS for predicting good outcome, with the area under receiver operating characteristics curve 0.70 (95% CI, 0.56-0.83; P = .011). CONCLUSION Higher baseline c-ASPECTS was a predictor for good clinical outcome in patients with ASPECTS &lt;6 treated with EVT, which could be helpful to treatment decision.

scholarly journals CT measurements of optic nerve sheath diameter to evaluate the outcome of acute carbon monoxide poisoning

2021 ◽  
Author(s):  
Jiayan han ◽  
Luo Zhuo ◽  
Dongmei Chen ◽  
Yan Sun ◽  
Fan Li ◽  
...  
Keyword(s):  
Carbon Monoxide ◽  
Optic Nerve ◽  
Roc Curve ◽  
Carbon Monoxide Poisoning ◽  
Good Outcome ◽  
Acute Carbon Monoxide Poisoning ◽  
Poor Outcome ◽  
Nerve Sheath ◽  
Poor Outcome Group ◽  
Outcome Group

Abstract Background Thousands of people die each year from carbon monoxide poisoning. There are no clear indicators for evaluating the outcome of carbon monoxide poisoning. We aimed to evaluate the relationship between optic nerve sheath diameter (ONSD) and ONSD/ transverse eyeball diameter ((ETD)) measured by CT and the outcome of acute carbon monoxide poisoning. Methods We retrospectively analyzed all acute carbon monoxide poisoning patients who had received CT November 2017 to July 2020. All patients underwent cranial CT examination on the day of admission, the ONSD at 3 mm behind the eyeball on CT was measured and the ONSD/ETD ratio was calculated by ETD. According to the CPC score, the patients were divided into two groups: good outcome group and poor outcome group. ROC curve was used to evaluate the diagnostic value of each index in outcome. Logistic regression analysis was used to screen the related factors affecting the outcome of patients. Results We identified 146 patients who received cranial CT as the first clinical evaluation after acute carbon monoxide poisoning, which including 108 patients with good outcome and 38 patients with poor outcome. Compared with the good outcome group, there were significant differences in ONSD, ONSO/ETD, Lactic acid, CPK, NSE, PSS and APACHEII scores between the poor outcome group and the poor outcome group. An ONSD model for predicting poor outcome was established, and the corresponding ROC curve was drawn. The area under the ROC curve (AUC) was 0.925, the best prediction probability out-off value was 0.3585, the sensitivity was 89.5%, and the specificity was 94.4%. The same method obtains the prediction model of ONSD/ETD, the AUC is 0.916, the out-off value of the best prediction probability is 0.3547, the sensitivity is 89.5%, and the specificity is 92.6%. Conclusion ONSD and ONSD/ETD are significantly related to the outcome of patients with acute carbon monoxide poisoning. The outcome is poor when ONSD > 5.68 mm or ONSD/ETD > 0.24. Measuring the diameter of optic nerve sheath by CT may be a simple and rapid method to evaluate the clinical outcome of patients with carbon monoxide poisoning.

scholarly journals Endovascular Treatment of Urgent Carotid Occlusion

2006 ◽  
Vol 12 (1_suppl) ◽  
pp. 233-240 ◽  
Author(s):  
K. Tsumura ◽  
N. Kuwayama ◽  
R. Iwai ◽  
T. Kanbayashi ◽  
H. Satoh ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Arterial Occlusion ◽  
Artery Occlusion ◽  
Carotid Occlusion ◽  
Simultaneous Treatment ◽  
Nihss Score ◽  
Good Outcome ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group

Emergency revascularization of acute carotid artery occlusion is still controversial. We treated 15 patients (13 men and two women, mean age of 67.3 years) with acute atherosclerotic carotid occlusion by endovascular procedures and evaluated the usefulness of this treatment. All of the patients were evaluated with emergency MRI and MRA before treatment. Intracranial tandem arterial occlusion due to distal embolism was observed in nine patients, and contralateral carotid stenosis (>70%) was observed in seven. The mean NIHSS score of the patients was 15.4±7.4 (mean±SD) before treatment. Treatment modality included local intraarterial fibrinolysis (LIF), percutaneous transluminal angioplasty (PTA), and carotid artery stenting (CAS). A protective balloon was successfully placed in the distal carotid artery through the plaque before recanalization in seven patients. Three patients were treated with LIF+PTA, five with PTA+CAS, six with LIF+PTA+CAS, and one with PTA only. Successful recanalization of the carotid artery was obtained in 14 of the 15 patients, and distal tandem middle cerebral artery occlusion was also successfully recanalized in eight of the nine patients. GOS was four or five in eight patients (good outcome group) and 1–3 in seven patients (poor outcome group). Mean NIHSS score of the 15 patients was (6.9 ± 7.4) after treatment. Preoperative NIHSS score (10.3 ± 7.4) in the good outcome group was significantly lower than that (21.3 ± 5.4) in the poor outcome group. The protective balloon technique, PTA with stenting, seems to be useful for acute revascularization of urgent carotid occlusion. Simultaneous treatment of the intracranial tandem occlusive lesion is essential to achieve good clini-cal results. Patients with acute carotid occlusion with NIHSS scores of less than 16 could be good candidates for this advanced treatment.

Aminotransferase as a prognostic index in infants with liver disease

1990 ◽  
Vol 36 (2) ◽  
pp. 346-348 ◽  
Author(s):  
P Rosenthal ◽  
M Haight
Keyword(s):  
Liver Disease ◽  
Prognostic Index ◽  
Prognostic Indicator ◽  
Liver Disorders ◽  
Good Outcome ◽  
Poor Outcome ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Serum Aspartate Aminotransferase

Abstract To assess the utility of the serum aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio in a group of infants with liver disorders, we retrospectively analyzed the charts of 73 infants with chronic liver disorders. Patients were considered as having either a good outcome (n = 40) or a poor outcome (n = 33), based upon the clinical course. AST and ALT in serum were measured simultaneously at the time of initial presentation and at various follow-up visits during the first 13 months after birth. At presentation (mean age 1.65 months), there was no difference in the AST/ALT ratios between the good (1.61 +/- 0.62; mean +/- SD) and poor (1.65 +/- 0.78) outcome groups (P = 0.81). However, over time, the AST/ALT ratio increased in patients in the poor-outcome group and decreased in patients in the good-outcome group. Calculating the AST/ALT ratio appears to be an easy, early, and reliable prognostic indicator for infants with hepatic disease, and may be a useful measure for evaluating liver-disease patients.

Abstract 9724: Variance of the Intracranial Pressure Over Time and Relationship With Neurologic Prognosis in Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Hogul Song ◽  
Yeonho You ◽  
Changshin Kang ◽  
Jung Soo Park
Keyword(s):  
Cardiac Arrest ◽  
Intracranial Pressure ◽  
Temperature Management ◽  
Poor Outcome ◽  
The Poor ◽  
Poor Outcome Group ◽  
Outcome Group ◽  
Poor Outcomes ◽  
Over Time ◽  
Center Study

Introduction: Increased intracranial pressure (ICP) is one of the most serious post-cardiac arrest (CA) complications, and is associated with poor outcomes. However, only a few studies have described the changes in ICP over time according to neurologic outcomes during targeted temperature management (TTM) after CA. We aimed to investigate the changes in the ICP over time and neurologic prognosis in out-of-hospital cardiac arrest (OHCA) survivors who received TTM. Methods: This retrospective single-center study included OHCA survivors who underwent TTM between May 2018 and December 2020. ICP was measured immediately after the return of spontaneous circulation (ROSC) (Day 1), and after 24 h (Day 2), 48 h (Day 3), and 72 h (Day 4) by connecting a lumbar drain. The neurologic outcome was determined 3 months after the ROSC, and the Cerebral Performance Category (CPC) was dichotomized into good (CPC 1-2) and poor (CPC 3-5) outcomes. Results: We included 91 patients (males, 67; 74%); of whom 51 (56%) had a poor outcome. The ICP was significantly higher in the poor outcome group at each time point, except for Day 4. Moreover, the peak ICP levels were also higher in the poor outcome group (17.0 vs. 14.8; P = 0.002). The change in ICP levels was highest between Day 2 and Day 3 in the good outcome group, but between Day 1 and Day 2 in the poor outcome group. However, there was no difference in the total ICP change between the poor and good outcome groups (3.00 vs 3.09; P = 0.52). Using receiver operating characteristic analyses, the optimal cutoff values of the ICP levels for the prediction of poor outcomes were determined as: day 1, > 11.8; day 2, > 14.0; day 3, > 15.0; and day 4, > 14.8. Conclusions: All OHCA survivors who received TTM had an elevated ICP, regardless of the neurologic prognosis. However, peak ICP levels and the change in the ICP level on the first day after the ROSC was significantly higher in the poor outcome group. A prospective, multi-center study is required to confirm these results.

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