Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
Intern Emerg Med. 2010 Dec;5(6):533-8. doi: 10.1007/s11739-010-0403-8. Epub 2010 May 8.
Patients who initially survive cardiac arrest are often admitted to an intensive care unit comatose and on mechanical ventilation. It is not clear whether or not a screening cranial computed tomography (CT scan) is necessary in the immediate post-arrest period. We hypothesized that there may be clinically relevant information gleaned from head CT scans obtained early in the post-arrest period that could affect immediate management of these patients, even when non-neurologic causes of cardiac arrest are suspected. A retrospective data analysis was conducted of all survivors (age >18 years) of non-traumatic out-of-hospital cardiac arrest (OHCA) who underwent non-contrast head CT (NCHCT) within the first 24 h of admission. A total of 84 patients were identified and 51 (60.7%) met the inclusion criteria. As much as 45 (88.2%) patients in the total cohort had an NCHCT negative for ICH or herniation; of this group, 39 (76.5%) had a normal NCHCT, while six (11.8%, 95% CI: 5.1-23.8%) demonstrated varying degrees of cerebral edema or loss of gray-white matter distinction consistent with anoxic brain injury, but without herniation. Six patients (11.8%, 95% CI: 5.1-23.8%) exhibited findings consistent with either an ICH (with or without herniation) or herniation without an ICH. Four (7.8%) of these patients had an ICH without herniation, one had an acute SAH with edema and herniation, and one had frank herniation due to massive cerebral edema. The overall incidence of any kind of intracranial hemorrhage in our cohort was 9.8% (95% CI: 3.8-21.4%). In this cohort of post-cardiac arrest patients who underwent cranial computed tomography, 11.8% of patients had clinically significant abnormalities identified. The exact role of neuroimaging in this population is still in evolution, and further prospective evaluation is warranted.
在心脏骤停初始幸存的患者经常被送入重症监护病房，处于昏迷状态并接受机械通气。目前尚不清楚在心脏骤停后即刻是否需要进行颅脑 CT （CT 扫描）筛查。我们假设，在心脏骤停后即刻获得的头部 CT 扫描中可能会获得有临床意义的信息，这些信息可能会影响这些患者的即时治疗，即使怀疑心脏骤停的非神经原因。对所有在院外非创伤性心脏骤停（OHCA）后 24 小时内接受非增强头部 CT （NCHCT）的幸存者（年龄> 18 岁）进行了回顾性数据分析。共确定了 84 例患者，其中 51 例（60.7%）符合纳入标准。在总队列中，多达 45 例（88.2%）患者的 NCHCT 未见 ICH 或脑疝；其中 39 例（76.5%）的 NCHCT 正常，6 例（11.8%，95%CI：5.1-23.8%）表现出不同程度的脑水肿或灰白质分界丧失，符合缺氧性脑损伤，但无脑疝。6 例（11.8%，95%CI：5.1-23.8%）患者的表现与 ICH （有或无脑疝）或无脑疝的脑疝一致。其中 4 例（7.8%）患者有 ICH 而无脑疝，1 例有急性蛛网膜下腔出血伴水肿和脑疝，1 例有大量脑水肿引起的脑疝。在我们的队列中，颅内出血的总发生率为 9.8%（95%CI：3.8-21.4%）。在接受颅脑 CT 检查的心脏骤停后患者队列中，11.8%的患者发现有临床意义的异常。神经影像学在这一人群中的确切作用仍在发展中，需要进一步的前瞻性评估。
