Francoeur Conall, Hornby Laura, Lehr Anab, Alkharusi Ahmed, Boyd J Gordon, Saint Martin Christine, Poulin Chantal, Slater Fiona, Kirschen Matthew P, Shemie Sam D
McGill University Health Centre (Montreal Children's Hospital), Montreal, QC, Canada.
Ron Gottesman Division of Pediatric Critical Care Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
Can J Anaesth. 2025 May 20. doi: 10.1007/s12630-025-02937-z.
Cardiac arrest can cause hypoxic-ischemic injury and result in both spinal cord injury and death determination by neurologic criteria (DNC). The presence and severity of hypoxic-ischemic spinal cord injury (HISCI) impacts neuro-prognostication, rehabilitation, and may confound DNC evaluation in patients by interfering with motor responses and respiratory muscle function in apnea testing. We describe five children with postarrest HISCI detected on magnetic resonance imaging (MRI) and supplement our observations with a literature review.
Postarrest HISCI was identified in five consecutive pediatric cases of prolonged cardiac arrest and hypoxic-ischemic brain injury in a single centre. All patients had cardiopulmonary resuscitation for > 30 min and resultant severe hypoxic-ischemic brain injury. Spinal MRI indications were loss of rectal tone (n = 3), focal deficit (n = 1), and practice change related to recent cases (n = 1). A rapid review of the literature yielded case reports, case series, and retrospective reviews describing 90 patients (81 adults; nine pediatric) with postarrest HISCI. Ischemia distribution was variable, most frequently reported at the cervical and thoracic levels, although some patients had ischemia of the entire cord. Paraplegia was the most common deficit among survivors. There were no reports of HISCI in patients who underwent assessment for DNC.
This case series and rapid literature review highlights that both adults and children may be at risk of HISCI after prolonged cardiac arrest. Our findings suggest that further research should focus on determining the incidence and sequelae of HISCI after resuscitated cardiac arrest, as well as evaluating its potential impact on DNC practice and neuro-prognostication.
心脏骤停可导致缺氧缺血性损伤，进而引起脊髓损伤，并导致根据神经学标准判定的死亡（DNC）。缺氧缺血性脊髓损伤（HISCI）的存在及严重程度会影响神经预后评估和康复，并且在进行呼吸暂停测试时，可能通过干扰运动反应和呼吸肌功能而混淆患者的DNC评估。我们描述了5例在磁共振成像（MRI）上检测到心脏骤停后发生HISCI的儿童，并通过文献综述补充了我们的观察结果。
在一个中心，连续5例儿科患者在长时间心脏骤停和缺氧缺血性脑损伤后被诊断为心脏骤停后HISCI。所有患者均接受了超过30分钟的心肺复苏，并由此导致严重的缺氧缺血性脑损伤。脊髓MRI的指征包括直肠张力丧失（n = 3）、局灶性缺损（n = 1）以及与近期病例相关的实践变化（n = 1）。对文献的快速回顾发现了病例报告、病例系列以及回顾性综述，描述了90例心脏骤停后发生HISCI的患者（81例成人；9例儿科患者）。缺血分布情况各不相同，最常报道的是颈段和胸段，不过有些患者整个脊髓都有缺血。截瘫是幸存者中最常见的缺陷。没有关于接受DNC评估的患者发生HISCI的报道。
这个病例系列和快速文献综述强调，成人和儿童在长时间心脏骤停后都可能有发生HISCI的风险。我们的研究结果表明，进一步的研究应侧重于确定复苏后心脏骤停后HISCI的发生率和后遗症，以及评估其对DNC实践和神经预后评估的潜在影响。
