Department of Emergency Medicine, Beaumont Health System, Royal Oak, Michigan, USA.
Geisinger Medical Center, Danville, Pennsylvania, USA.
Ther Hypothermia Temp Manag. 2021 Sep;11(3):164-169. doi: 10.1089/ther.2020.0026. Epub 2020 Oct 6.
Head computed tomography (HCT) is often performed postcardiac arrest to assess for hypoxic-ischemic brain injury. Our primary objective was to assess whether cerebral edema (CE) on early HCT is associated with poor survival and neurologic outcome after out-of-hospital cardiac arrest (OHCA).We included subjects from a prospectively collected database of OHCA adults who received targeted temperature management at two hospitals from July 2009 to July 2018. We included cases if an emergency department (ED) HCT was performed. Patient demographics and cardiac arrest variables were collected. HCT results were abstracted from radiology reports. HCT findings were categorized as no acute disease, evidence of CE, or excluded (bleed, tumor, and stroke). Outcomes were survival to discharge or dichotomized discharge cerebral performance category (CPC) of 1-2 (good neurologic outcome) versus 3-5 (poor neurologic outcome). Univariate and multivariate analyses were performed. There were 425 OHCA, of which 315 had ED HCT with 277 cases included. Patients were predominately male (65.0%), average age of 60.9 years and average body mass index of 30.5. Of all cases, 44 (15.9%) showed CE on computed tomography. Univariate analysis demonstrated that CE was associated with 9.2-fold greater odds of poor outcome (odds ratio [OR]: 9.23; 95% confidence interval [CI] 1.73-49.2) and 9.1-fold greater odds of death (OR: 9.09, 95% CI 2.4-33.9). In adjusted analysis, CE was associated with a poor CPC outcome (adjusted odds ratios [AOR]: 14.9, 95% CI 2.49-88.4), and death (AOR: 13.7, 95% CI 3.26-57.4). Adjusted survival analysis demonstrated that patients with CE on HCT had 3.6-fold greater hazard of death than those without CE (hazard ratios 3.56, 95% CI 2.34-5.41). The results identify that CE on HCTs early in the postarrest period in OHCA patients is strongly associated with poor rates of survival and neurologic outcome. Prospective work is needed to further define the role of early HCT in postarrest neuroprognostication.
头部计算机断层扫描（HCT）常用于评估心脏骤停后是否存在缺氧缺血性脑损伤。我们的主要目的是评估心脏骤停后（OHCA）患者早期 HCT 上的脑水肿（CE）是否与生存和神经预后不良相关。
我们纳入了 2009 年 7 月至 2018 年 7 月期间在两家医院接受目标温度管理的 OHCA 成年患者前瞻性收集数据库中的患者。纳入了急诊科（ED） HCT 检查的病例。收集了患者人口统计学和心脏骤停变量。HCT 结果从放射学报告中提取。HCT 结果分为无急性疾病、有 CE 证据和排除（出血、肿瘤和中风）。结局为出院时生存或出院时二分法脑功能预后分类（CPC）为 1-2（良好神经预后）与 3-5（不良神经预后）。进行了单变量和多变量分析。
共纳入了 425 例 OHCA，其中 315 例行 ED HCT，纳入 277 例。患者主要为男性（65.0%），平均年龄 60.9 岁，平均体重指数为 30.5。所有病例中，44 例（15.9%）的 CT 显示有 CE。单变量分析表明，CE 与不良结局的可能性增加 9.2 倍相关（比值比[OR]：9.23；95%置信区间[CI] 1.73-49.2），与死亡的可能性增加 9.1 倍相关（OR：9.09，95%CI 2.4-33.9）。在调整分析中，CE 与 CPC 预后不良相关（调整后的比值比[AOR]：14.9，95%CI 2.49-88.4）和死亡相关（AOR：13.7，95%CI 3.26-57.4）。调整后的生存分析表明，HCT 上有 CE 的患者死亡的危险是没有 CE 的患者的 3.6 倍（危险比 3.56，95%CI 2.34-5.41）。结果表明，OHCA 患者心脏骤停后早期 HCT 上的 CE 与生存率和神经预后不良密切相关。需要前瞻性研究进一步确定早期 HCT 在心脏骤停后神经预后中的作用。
