• Alexandra Schick, Matthew E Prekker, Robert R Kempainen, Maximilian Mulder, Johanna Moore, Danika Evans, Jeffrey Hall, Holly Rodin, Jeffrey Larson, and Andrew Caraganis.
• Division of Pulmonary and Critical Care, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN, United States of America. Electronic address: schic106@umn.edu.
• Am J Emerg Med. 2022 Apr 1; 54: 257-262.

AimThis study aimed to describe the prevalence of hypoxic-ischemic brain injury (HIBI) on head CT (HCT) obtained within two hours of return of spontaneous circulation (ROSC) care in the Emergency Department following out-of-hospital cardiac arrest (OHCA) and evaluate the association between early HIBI and neurologic outcome.MethodsRetrospective single center observational study of post-OHCA patients between 2009 and 2017. Two cohorts were analyzed: those who underwent non-contrast HCT within two hours of ROSC and all others who survived to ICU admission. HIBI was defined as the presence of cerebral edema and/or abnormal gray-white matter differentiation in the HCT interpretation by a neuroradiologist. The primary outcomes were the prevalence of HIBI on early HCT and the magnitude of the association between HIBI and survival with good neurologic outcome using multivariable logistic regression.ResultsFollowing OHCA, 333 of 520 patients (64%) underwent HCT within two hours of ROSC and HIBI was present in 96 of 333 patients (29%). Of the early HCT cohort, those with HIBI had a significantly lower hospital survival (2%) and favorable neurologic outcome (1%). In those without HIBI on imaging, 88 of 237 patients (37%) had a favorable outcome. After adjustment for confounding variables, HIBI on early HCT was independently associated with a decreased likelihood of good neurologic outcome (aOR 0.015, 95% CI 0.002-0.12).ConclusionHIBI was present on 29% of HCTs obtained within 2 h of ROSC in the patients selected for early imaging by emergency physicians and was strongly and inversely associated with survival with a good neurologic outcome.Copyright © 2022 Elsevier Inc. All rights reserved.

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