Department of Emergency Medicine, Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Rd., Banciao Dist., New Taipei City, 220, Taiwan.
BMC Emerg Med. 2022 May 6;22(1):77. doi: 10.1186/s12873-022-00634-4.
The sign of contrast agent pooling (C.A.P.) in dependent part of the venous system were reported in some case reports, which happened in the patients before sudden cardiac arrest. Until now, there is no solid evidence enough to address the importance of the sign. This study aimed to assess the accuracy of the C.A.P. sign in predicting imminent cardiac arrest and the association of the C.A.P. sign with patient's survival.
This is a retrospective cohort study. The study included all patients who visited the emergency department, who received contrast computed tomography (CT) scan and then experienced cardiac arrest at the emergency department (from January 1, 2016 to December 31, 2018). We evaluated the occurrence of the C.A.P. sign on the chest or abdominal CT scan, patients with ECMO were excluded. With positive C.A.P. sign, the primary outcome is whether in-hospital cardiac arrest happens within an hour; the accuracy of C.A.P. sign was calculated. The secondary outcome is survival to discharge.
In the study, 128 patients were included. 8.6% (N = 11) patients had positive C.A.P. sign and 91.4% (N = 117) patients did not. The accuracy of C.A.P. sign in predicting cardiac arrest within 1 h was 85.94%. The C.A.P. sign had a positive association with IHCA within 1 h after the CT scan (adjusted odds ratio 7.35, 95% confidence interval [CI] 1.27 - 42.69). The relative risk (RR) of survival to discharge was 0.90 with positive C.A.P. sign (95% CI 0.85 - 0.96).
The C.A.P. sign can be considered as an alarm for imminent cardiac arrest and poor prognosis. The patients with positive C.A.P. sign were more likely to experience imminent cardiac arrest; in contrast, less likely to survive.
IRB No.108107-E.
在一些病例报告中，有人报道在一些心搏骤停前的患者中，静脉系统的依赖部位出现造影剂积聚（C.A.P.）的征象。到目前为止，还没有足够确凿的证据来确定该征象的重要性。本研究旨在评估 C.A.P. 征象预测即将发生的心搏骤停的准确性，以及 C.A.P. 征象与患者生存的相关性。
这是一项回顾性队列研究。该研究纳入了所有在急诊就诊、接受对比增强 CT 扫描，然后在急诊科发生心搏骤停的患者（2016 年 1 月 1 日至 2018 年 12 月 31 日）。我们评估了胸部或腹部 CT 扫描中 C.A.P. 征象的发生情况，排除了接受 ECMO 的患者。阳性 C.A.P. 征象的主要转归为 1 小时内院内心搏骤停的发生；计算 C.A.P. 征象的准确性。次要转归为出院存活。
在这项研究中，共纳入 128 例患者。8.6%（N=11）的患者 C.A.P. 征象阳性，91.4%（N=117）的患者 C.A.P. 征象阴性。C.A.P. 征象预测 1 小时内心搏骤停的准确性为 85.94%。C.A.P. 征象与 CT 扫描后 1 小时内 IHCA 呈正相关（调整后的优势比 7.35，95%置信区间 [CI] 1.27-42.69）。C.A.P. 征象阳性患者出院存活率的相对风险（RR）为 0.90（95%CI 0.85-0.96）。
C.A.P. 征象可视为即将发生心搏骤停和预后不良的警报。C.A.P. 征象阳性的患者更有可能发生即将发生的心搏骤停，而存活的可能性较低。
IRB No.108107-E。
