Association between chest computed tomography features and prognosis in patients treated with extracorporeal cardiopulmonary resuscitation

doi:10.5847/wjem.j.1920-8642.2025.083

Abstract

Abstract:

BACKGROUND: Previous studies have reported that early computed tomography (CT) findings significantly contribute to the outcomes of cardiac arrest (CA) patients. This study aims to evaluate the association between chest CT features and prognosis in CA patients treated with extracorporeal cardiopulmonary resuscitation (ECPR).

METHODS: A retrospective observational study was conducted on adult CA patients treated with ECPR in a tertiary hospital between March 2015 and June 2023. All the patients underwent a whole-body CT scan within 1 h of ECPR. Data regarding demographic and clinical characteristics were collected from electronic medical records. The presence of gravity-dependent distribution and CT scores based on chest CT scans were determined for each patient. The primary outcome was 28-day survival. Receiver operating characteristic (ROC) curves were used to evaluate the ability of chest CT features (gravity-dependent distribution and CT scores) to predict poor outcomes. The cut-off value of the CT score was determined. Kaplan-Meier curves were used to compare 28-day survival between the low- and high-CT score groups, which were classified using the estimated cut-off value.

RESULTS: Among the 100 patients included, 74 were non-survivors. The non-survivor patients showed a higher presence of gravity-dependent distribution and higher CT scores than survivors (P<0.05). Patients with gravity-dependent distribution had significantly higher CT scores than those with non-gravity-dependent distribution (P<0.05). The combination of CT score and gravity-dependent distribution predicted poor outcomes better than considering the features individually, demonstrating moderate performance (AUC: 0.693, 95% CI: 0.568-0.801). According to the survival analysis, the risk of death increased as the CT score rose, with an estimated cut-off value of ≥ 11 (P=0.016).

CONCLUSION: Chest CT features were associated with poor outcomes in CA patients following ECPR.

Key words: Cardiac arrest, Chest computed tomography, Extracorporeal cardiopulmonary resuscitation, Prognosis

Gannan Wang, Yi Zhu, Hao Zhou, Tao Ding, Yutong Shi, Xiaoquan Xu, Hai Xu, Wei Li, Xufeng Chen. Association between chest computed tomography features and prognosis in patients treated with extracorporeal cardiopulmonary resuscitation[J]. World Journal of Emergency Medicine, 2025, 16(6): 567-572.

Figures/Tables 6

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Characteristics	Survivors (n=26)	Non-survivors (n=74)	t/χ²/Z	P-value
Age, years, mean ± SD	49.42± 14.56	47.34± 17.79	0.537	0.592
Male, n (%)	16 (61.5)	65 (87.8)	7.022	0.008
BMI, kg/m², median (IQR)	24.28 (22.26-28.11)	24.36 (22.49-26.74)	-0.519	0.604
Co-morbidities, n (%)
Hypertension	11 (42.3)	28 (37.8)	0.162	0.688
Diabetes	6 (23.1)	9 (12.2)	1.044	0.307
Coronary heart disease	4 (15.4)	9 (12.2)	0.007	0.935
Chronic obstructive pulmonary disease	2 (7.7)	7 (9.5)	0.073	0.787
OHCA, n (%)	5 (19.2)	33 (44.6)	5.254	0.022
Bystander CPR, n (%)	23 (88.5)	56 (75.7)	1.896	0.169
Etiology, n (%)			5.122	0.077
AMI	11 (42.3)	46 (62.2)
AFM	7 (26.9)	7 (9.5)
Others	8 (30.8)	21 (28.4)
Initial shockable rhythm, n (%)	15 (57.7)	31 (41.9)	1.934	0.164
No-flow time, min, median (IQR)	0 (0-0.8)	0 (0-7.8)	-2.018	0.044
Low-flow time, min, median (IQR)	62.0 (46.8-116.0)	84.5 (50.8-102.0)	-0.943	0.346
Chest CT features
Gravity-dependent distribution*, n (%)	6 (23.1)	36 (48.6)	5.165	0.023
CT score, median (IQR)	5.8 (13.5-19.5)	19.0 (13.0-23.3)	-2.533	0.011

Outcomes	Low CT-score (n=23)	High CT-score (n=77)	P-value
Survival at discharge	11 (47.8)	15 (19.5)	0.007
Successful weaning from ECMO	12 (52.2)	16 (20.8)	0.003
Successful weaning from MV	11 (47.8)	12 (15.6)	0.001
CRRT	12 (52.2)	51 (66.2)	0.220
Favorable neurological outcomes (CPC 1-2)	10 (43.5)	9 (11.7)	0.002

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