Jeon So Young, Ahn Hong Joon, Kang Changshin, You Yeonho, Park Jung Soo, Min Jin Hong, Jeong Wonjoon, In Yong Nam
Department of Emergency Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon 35015, Republic of Korea.
Department of Emergency Medicine, College of Medicine, Chungnam National University School of Medicine, Daejeon 35015, Republic of Korea.
Brain Sci. 2024 Mar 21;14(3):297. doi: 10.3390/brainsci14030297.
Changes in cerebrospinal fluid (CSF) dynamics can have adverse effects on neuronal function. We hypothesized that patients with hypoxic-ischemic brain injury (HIBI) showing poor neurological outcomes after cardiac arrest (CA) would exhibit changes in CSF dynamics, leading to abnormalities in gas diffusion within the CSF. Therefore, we investigated the prognostic value of the CSF partial pressure of carbon dioxide (PcsfCO) in CA survivors who underwent targeted temperature management (TTM). We retrospectively analyzed the 6-month neurological outcomes, CSF, and arterial blood gas parameters of 67 CA survivors. Patients were divided into good and poor neurological outcome groups, and the predictive value of PcsfCO for poor neurological outcomes was assessed using receiver operating characteristic curve analysis. Among all patients, 39 (58.2%) had poor neurological outcomes. Significant differences in PcsfCO levels between the groups were observed, with lower PcsfCO levels on Day 1 showing the highest predictive value at a cutoff of 30 mmHg (area under the curve, sensitivity, and specificity were 0.823, 77.8%, and 79.0%, respectively). These results suggest that PcsfCO might serve not only as a unique marker for the severity of hypoxic-ischemic brain injury (HIBI), independent of extracorporeal CO levels, but also as an objective indicator of changes in CSF dynamics. This study highlights the potential prognostic and diagnostic utility of PcsfCO during TTM in CA survivors, emphasizing its importance in evaluating CSF dynamics and neurological recovery post CA. However, larger multicenter studies are warranted to address potential limitations associated with sample size and outcome assessment methods.
脑脊液（CSF）动力学的改变可能会对神经元功能产生不利影响。我们推测，心脏骤停（CA）后神经功能预后不良的缺氧缺血性脑损伤（HIBI）患者会出现脑脊液动力学改变，导致脑脊液内气体扩散异常。因此，我们研究了接受目标温度管理（TTM）的CA幸存者脑脊液二氧化碳分压（PcsfCO₂）的预后价值。我们回顾性分析了67例CA幸存者的6个月神经功能预后、脑脊液和动脉血气参数。将患者分为神经功能预后良好组和不良组，采用受试者工作特征曲线分析评估PcsfCO₂对不良神经功能预后的预测价值。在所有患者中，39例（58.2%）神经功能预后不良。观察到两组之间PcsfCO₂水平存在显著差异，第1天较低的PcsfCO₂水平在截断值为30 mmHg时显示出最高的预测价值（曲线下面积、敏感性和特异性分别为0.823、77.8%和79.0%）。这些结果表明，PcsfCO₂不仅可能作为缺氧缺血性脑损伤（HIBI）严重程度的独特标志物，独立于体外CO₂水平，而且还可作为脑脊液动力学变化 的客观指标。本研究强调了PcsfCO₂在CA幸存者TTM期间的潜在预后和诊断效用，强调了其在评估CA后脑脊液动力学和神经功能恢复中的重要性。然而，需要进行更大规模的多中心研究来解决与样本量和结局评估方法相关的潜在局限性。
