Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA.
Neurocrit Care. 2013 Apr;18(2):228-33. doi: 10.1007/s12028-012-9683-3.
Iatrogenic cerebral arterial gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits.
We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO2 at a state referral hyperbaric facility over a 22-year period. We analyzed the effect of demographics, source of intra-arterial gas, signs and symptoms, results of imaging studies, time between event and HBO2 treatment, and response to HBO2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms at 24 h after HBO2 treatment. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death.
A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7 ± 17.8 vs. 58.1 ± 24.1, p = 0.08). Cardiopulmonary symptoms were significantly more common in CAGE related to venous source of gas compared to arterial source (p = 0.024) but did not influence the rate of favorable outcomes. Adjusted multivariate analysis demonstrated that time from event to HBO2 ≤ 6 h (positively) and the presence of infarct/edema on head computerized tomography (CT)/magnetic resonance imaging (MRI) before HBO2 (negatively) were independent predictors of favorable outcome at 24 h after HBO2 treatment [odds ratio (OR) 9.08 confidence interval (CI) (1.13-72.69), p = 0.0376, and (OR) 0.034 (CI) (0.002-0.58), p = 0.0200, respectively]. Two of the 36 patients were treated with thrombolytics because of acute focal deficits and suspected ischemia-one with intravenous and the second with intra-arterial thrombolysis. The latter patient developed fatal intracerebral hemorrhage.
A high proportion of CAGE patients treated with HBO2 had favorable outcomes. Time-to-HBO2 ≤ 6 h increased the odds of favorable outcome, whereas the presence of infarct/edema on CT/MRI scan before HBO2 reduced the odds of a favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events appears to be an important determinant of successful HBO2 treatment.
医源性脑动脉气体栓塞（CAGE）是一种罕见但潜在致命的疾病。高压氧（HBO2）治疗是治疗出现急性神经功能缺损的 CAGE 患者的唯一明确治疗方法。
我们回顾了在一家州立转诊高压氧治疗中心接受 HBO2 治疗的连续 22 年的 CAGE 患者的病历和神经影像学资料。我们分析了人口统计学、动脉内气体来源、体征和症状、影像学研究结果、事件发生与 HBO2 治疗之间的时间以及 36 例连续患者对 HBO2 治疗的反应。良好的结果定义为 HBO2 治疗后 24 小时 CAGE 体征和症状完全缓解或改善。不良结果定义为神经体征和症状无变化或恶化或住院死亡。
共有 26 例（72%）患者的结果良好。与结果不佳的患者相比，结果良好的患者年龄较小（平均年龄[岁，标准差]44.7 ± 17.8 岁 vs. 58.1 ± 24.1 岁，p = 0.08）。与动脉来源相比，静脉来源的 CAGE 相关气体更常伴有心肺症状（p = 0.024），但并不影响良好结果的发生率。调整后的多变量分析表明，HBO2 治疗前 6 小时内发生事件（阳性）和头部计算机断层扫描（CT）/磁共振成像（MRI）上存在梗死/水肿（阴性）是 HBO2 治疗后 24 小时良好结果的独立预测因素[比值比（OR）9.08 置信区间（CI）（1.13-72.69），p = 0.0376，和（OR）0.034（CI）（0.002-0.58），p = 0.0200]。由于急性局灶性缺损和疑似缺血，有 2 例 CAGE 患者接受了溶栓治疗-1 例静脉内溶栓，另 1 例动脉内溶栓。后者发生致命性颅内出血。
接受 HBO2 治疗的 CAGE 患者中，有很大比例的患者预后良好。HBO2 治疗前 6 小时内发生事件的时间增加了良好结果的几率，而 HBO2 治疗前 CT/MRI 扫描上存在梗死/水肿降低了良好结果的几率。及时诊断和区分血栓栓塞性缺血事件似乎是成功 HBO2 治疗的重要决定因素。
