1. Brain computed tomography after resuscitation from in-hospital cardiac arrest.
- Author
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Ratay C, Elmer J, Callaway CW, Flickinger KL, and Coppler PJ
- Subjects
- Humans, Male, Female, Retrospective Studies, Middle Aged, Aged, Brain diagnostic imaging, Coma etiology, Tomography, X-Ray Computed methods, Tomography, X-Ray Computed statistics & numerical data, Cardiopulmonary Resuscitation methods, Cardiopulmonary Resuscitation adverse effects, Brain Edema etiology, Brain Edema diagnostic imaging, Out-of-Hospital Cardiac Arrest therapy, Out-of-Hospital Cardiac Arrest etiology, Out-of-Hospital Cardiac Arrest diagnostic imaging, Heart Arrest therapy, Heart Arrest etiology
- Abstract
Background: Few data characterize the role of brain computed tomography (CT) after resuscitation from in-hospital cardiac arrest (IHCA). We hypothesized that identifying a neurological etiology of arrest or cerebral edema on brain CT are less common after IHCA than after resuscitation from out-of-hospital cardiac arrest (OHCA)., Methods: We included all patients comatose after resuscitation from IHCA or OHCA in this retrospective cohort analysis. We abstracted patient and arrest clinical characteristics, as well as pH and lactate, to estimate systemic illness severity. Brain CT characteristics included quantitative measurement of the grey-to-white ratio (GWR) at the level of the basal ganglia and qualitative assessment of sulcal and cisternal effacement. We compared GWR distribution by stratum (no edema ≥1.30, mild-to-moderate <1.30 and >1.20, severe ≤1.20) and newly identified neurological arrest etiology between IHCA and OHCA groups., Results: We included 2,306 subjects, of whom 420 (18.2%) suffered IHCA. Fewer IHCA subjects underwent post-arrest brain CT versus OHCA subjects (149 (35.5%) vs 1,555 (82.4%), p < 0.001). Cerebral edema for IHCA versus OHCA was more often absent (60.1% vs. 47.5%) or mild-to-moderate (34.3% vs. 27.9%) and less often severe (5.6% vs. 24.6%). A neurological etiology of arrest was identified on brain CT in 0.5% of IHCA versus 3.2% of OHCA., Conclusions: Although severe edema was less frequent in IHCA relative to OHCA, mild-to-moderate or severe edema occurred in one in three patients after IHCA. Unsuspected neurological etiologies of arrest were rarely discovered by CT scan in IHCA patients., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Elmer receives research funding from the National Institutes of Health to study brain recovery after cardiac arrest including evaluation of temperature management (R01NS124642; R01NS119825, K23NS097692). Dr. Callaway receives research funding from the National Institutes of Health to study emergency treatments including recovery after cardiac arrest and temperature management (U24NS100659; U24NS100656). Dr. Callaway and Dr. Elmer are both members of the Editorial Board of Resuscitation., (Copyright © 2024 Elsevier B.V. All rights reserved.)
- Published
- 2024
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