Highland Hospital Department of Emergency Medicine, Alameda Health System, Oakland, CA USA; University of California San Francisco Department of Emergency Medicine, San Francisco, CA USA.
Highland Hospital Department of Emergency Medicine, Alameda Health System, Oakland, CA USA.
Am J Emerg Med. 2021 Mar;41:70-72. doi: 10.1016/j.ajem.2020.12.015. Epub 2020 Dec 30.
Intracranial Hemorrhage (ICH) is an important cause of out-of-hospital cardiac arrest (OHCA), yet there are no United States (US), European, or Australian prospective studies examining its incidence in patients who sustained OHCA. This study aims to identify the incidence of ICH in US patients with OHCA who obtain return of spontaneous circulation (ROSC).
We prospectively analyzed consecutive patients with OHCA who achieved ROSC at a single US hospital over a 15-month period. Before beginning patient enrollment, we implemented a standardized emergency department order-set for the initial management for all patients with ROSC after OHCA. This order-set included a non-contrast head computed-tomography (NCH-CT) scan. Patient and cardiac arrest variables were recorded, as were NCH-CT findings.
During the study period, 85 patients sustained an OHCA, achieved ROSC, survived to hospital admission, and underwent a NCH-CT. Three of these 85 patients had ICH (3.5%). Survival to discharge was seen in 23/82 (28.0%) patients without ICH and in 1/3 patients with ICH. Survival with good neurologic outcome was seen in 14/82 (17.1%) patients without ICH and in 0/3 patients with ICH. Patients with ICH tended to be older than patients without ICH.
In our US cohort, ICH was an uncommon finding in patients who sustained OHCA and survived to hospital admission, and no patients with ICH survived to discharge with good neurologic outcome. Additionally, the incidence of ICH was lower than reported in previous studies.
颅内出血（ICH）是院外心脏骤停（OHCA）的重要原因，但目前尚无美国、欧洲或澳大利亚的前瞻性研究调查 OHCA 患者中 ICH 的发生率。本研究旨在确定在美国 ROSC 恢复的 OHCA 患者中 ICH 的发生率。
我们前瞻性分析了在一家美国医院 15 个月期间发生 OHCA 并恢复自主循环（ROSC）的连续患者。在开始患者入组之前，我们为所有 ROSC 后的 OHCA 患者实施了一个标准化的急诊科医嘱集，包括非对比头部计算机断层扫描（NCH-CT）。记录患者和心脏骤停变量以及 NCH-CT 结果。
在研究期间，85 例患者发生 OHCA，ROSC 恢复，存活至入院，并进行了 NCH-CT。这 85 例患者中有 3 例（3.5%）患有 ICH。无 ICH 的 82 例患者中有 23 例（28.0%）存活至出院，有 ICH 的 3 例患者中有 1 例存活至出院。无 ICH 的 82 例患者中有 14 例（17.1%）存活且神经功能良好，有 ICH 的 3 例患者中无一例存活且神经功能良好。ICH 患者的年龄往往大于无 ICH 患者。
在我们的美国队列中，ICH 是 OHCA 存活至入院的患者中罕见的发现，并且没有 ICH 患者存活至出院且神经功能良好。此外，ICH 的发生率低于先前研究报告的发生率。
