Division of Pulmonary and Critical Care, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN, United States of America.
Division of Pulmonary and Critical Care, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN, United States of America; Department of Emergency Medicine, Hennepin County Medical Center, 701 Park Ave S, Minneapolis, MN, United States of America.
Am J Emerg Med. 2022 Apr;54:257-262. doi: 10.1016/j.ajem.2022.02.003. Epub 2022 Feb 5.
This study aimed to describe the prevalence of hypoxic-ischemic brain injury (HIBI) on head CT (HCT) obtained within two hours of return of spontaneous circulation (ROSC) care in the Emergency Department following out-of-hospital cardiac arrest (OHCA) and evaluate the association between early HIBI and neurologic outcome.
Retrospective single center observational study of post-OHCA patients between 2009 and 2017. Two cohorts were analyzed: those who underwent non-contrast HCT within two hours of ROSC and all others who survived to ICU admission. HIBI was defined as the presence of cerebral edema and/or abnormal gray-white matter differentiation in the HCT interpretation by a neuroradiologist. The primary outcomes were the prevalence of HIBI on early HCT and the magnitude of the association between HIBI and survival with good neurologic outcome using multivariable logistic regression.
Following OHCA, 333 of 520 patients (64%) underwent HCT within two hours of ROSC and HIBI was present in 96 of 333 patients (29%). Of the early HCT cohort, those with HIBI had a significantly lower hospital survival (2%) and favorable neurologic outcome (1%). In those without HIBI on imaging, 88 of 237 patients (37%) had a favorable outcome. After adjustment for confounding variables, HIBI on early HCT was independently associated with a decreased likelihood of good neurologic outcome (aOR 0.015, 95% CI 0.002-0.12).
HIBI was present on 29% of HCTs obtained within 2 h of ROSC in the patients selected for early imaging by emergency physicians and was strongly and inversely associated with survival with a good neurologic outcome.
本研究旨在描述急诊科复苏后 2 小时内获得的头部 CT（HCT）显示的缺氧缺血性脑损伤（HIBI）的发生率，并评估早期 HIBI 与神经功能预后的相关性。
这是一项 2009 年至 2017 年期间进行的回顾性单中心观察性研究，纳入院外心脏骤停（OHCA）后患者。分析了两个队列：在 ROSC 后 2 小时内行非对比 HCT 的患者，以及存活至 ICU 入住的所有其他患者。HIBI 定义为神经放射科医生对 HCT 解读中存在脑水肿和/或灰白质分化异常。主要结局是早期 HCT 上 HIBI 的发生率以及 HIBI 与生存和良好神经功能结局之间的关联程度，使用多变量逻辑回归进行评估。
OHCA 后，520 例患者中有 333 例（64%）在 ROSC 后 2 小时内行 HCT，其中 96 例（29%）存在 HIBI。在早期 HCT 队列中，HIBI 患者的院内生存率（2%）和良好神经功能结局率（1%）显著降低。在无 HIBI 的患者中，237 例（37%）有良好的结局。在校正混杂变量后，早期 HCT 上的 HIBI 与良好神经功能结局的可能性降低独立相关（aOR 0.015，95%CI 0.002-0.12）。
在选择进行早期影像学检查的患者中，急诊科医生在 ROSC 后 2 小时内获得的 HCT 中，29%存在 HIBI，且 HIBI 与良好神经功能结局的生存率呈强烈负相关。
