Background: We evaluated whether Alberta Stroke Program Early Computed Tomography Score (ASPECTS) with\nsome modifications could be used to predict neurological outcomes in patients after extracorporeal\ncardiopulmonary resuscitation (ECPR).\nMethods: This was a retrospective, multicenter, observational study of adult unconscious patients who were evaluated\nby brain computed tomography (CT) within 48 hours after ECPR between May 2010 and December 2016. ASPECTS,\nbilateral ASPECTS (ASPECTS-b), and modified ASPECTS (mASPECTS) were assessed by ROC curves to predict neurological\noutcomes. The primary outcome was neurological status upon hospital discharge assessed with the Cerebral Performance\nCategories (CPC) scale.\nResults: Among 58 unconscious patients, survival to discharge was identified in 25 (43.1%) patients. Of these 25\nsurvivors, 19 (32.8%) had good neurological outcomes (CPC score of 1 or 2). Interrater reliability of CT scores was\nexcellent. Intraclass correlation coefficients of ASPECTS, ASPECTS-b, and mASPECTS were 0.918 (95% CI, 0.865â??0.950),\n0.918 (95% CI, 0.866â??0.951), and 0.915 (95% CI, 0.860â??0.949), respectively. The predictive performance of mASPECTS for\npoor neurological outcome was better than that of ASPECTS or ASPECTS-b (C-statistic for mASPECTS vs. ASPECTS, 0.922\nvs. 0.812, p = 0.004; mASPECTS vs. ASPECTS-b, 0.922 vs. 0.818, p = 0.003). A cutoff of 25 for poor neurological outcome\nhad a sensitivity of 84.6% (95% CI, 69.5â??94.1%) and a specificity of 89.5% (95% CI, 66.9â??98.7%) in mASPECTS.\nConclusions: mASPECTS might be useful for predicting neurological outcomes in patients after ECPR.
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