Resuscitation Plus (Dec 2020)
Impact of delayed hyperenhancement obtained by non-contrast computed tomography following coronary angiography in patients undergoing extracorporeal cardiopulmonary resuscitation
Abstract
Background: Extracorporeal cardiopulmonary resuscitation (ECPR) has the potential to improve outcomes in patients with refractory cardiac arrest. However, the outcome is difficult to predict on admission. Recent reports have described early evaluation of myocardial damage in patients with acute myocardial infarction by detecting delayed enhancement in non-contrast computed tomography (CT) following coronary angiography (CAG). We investigated the impact of delayed hyperenhancement obtained by non-contrast CT following CAG in patients with ischaemic and non-ischaemic cardiovascular diseases who underwent ECPR for refractory cardiac arrest. Methods: Forty-two patients who underwent ECPR, CAG, and postprocedural CT for refractory cardiac arrest in our institute were retrospectively enrolled. Two blinded readers independently and semi-quantitatively judged whether hyperenhancement was present or absent in non-contrast axial CT images following CAG. We evaluated the relationship between in-hospital death and delayed hyperenhancement. Results: The identification of delayed hyperenhancement was highly consistent between the two readers (kappa = 0.71). The survival rate was 21.4% in this cohort. The only significant difference between the survival group and in-hospital death group was the presence of delayed hyperenhancement, which was detected only in the in-hospital death group (p = 0.03). The prevalence of cardiac death was higher in patients with than without delayed hyperenhancement. Delayed hyperenhancement was observed even in areas perfused by non-obstructive coronary arteries. Conclusions: Delayed hyperenhancement of the left ventricular wall on non-contrast CT imaging following CAG might help to predict in-hospital death in patients undergoing ECPR for refractory cardiac arrest.
