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Abstract：
Iatrogenic cerebral arterial gas embolism (CAGE) caused by invasive medical procedures may be treated with hyperbaric oxygen therapy (HBOT). Previous studies suggested that initiation of HBOT within 6-8 h is associated with higher probability of favorable outcome, when compared to time-to-HBOT beyond 8 h. We performed a group level and individual patient level meta-analysis of observational studies, to evaluate the relationship between time-to-HBOT and outcome after iatrogenic CAGE.
We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model.
Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6-9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h.
Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.
We systematically searched for studies reporting on time-to-HBOT and outcome in patients with iatrogenic CAGE. On group level, we meta-analyzed the differences between median time-to-HBOT in patients with favorable versus unfavorable outcome. On individual patient level, we analyzed the relationship between time-to-HBOT and probability of favorable outcome in a generalized linear mixed effects model.
Group level meta-analysis (ten studies, 263 patients) shows that patients with favorable outcome were treated with HBOT 2.4 h (95% CI 0.6-9.7) earlier than patients with unfavorable outcome. The generalized linear mixed effects model (eight studies, 126 patients) shows a significant relationship between time-to-HBOT and probability of favorable outcome (p = 0.013) that remains significant after correcting for severity of manifestations (p = 0.041). Probability of favorable outcome decreases from approximately 65% when HBOT is started immediately, to 30% when HBOT is delayed for 15 h.
Increased time-to-HBOT is associated with decreased probability of favorable outcome in iatrogenic CAGE. This suggests that early initiation of HBOT in iatrogenic CAGE is of vital importance.
摘要：
背景：由侵入性医疗程序引起的医源性脑动脉气体栓塞（CAGE）可以通过高压氧治疗（HBOT）进行治疗。先前的研究表明，在6-8小时内开始HBOT与较高的有利结局概率相关，与超过8小时的HBOT时间相比，我们对观察性研究进行了组水平和个体患者水平的荟萃分析，评估医源性CAGE后HBOT时间与结局之间的关系。
方法：我们系统地研究了医源性CAGE患者的HBOT时间和预后。在组级别，我们荟萃分析了结局有利和不利患者的中位HBOT时间之间的差异.在个体患者层面上，我们在广义线性混合效应模型中分析了HBOT时间与有利结果概率之间的关系.
结果：组水平的荟萃分析（十项研究，263例患者）显示，预后良好的患者比预后不良的患者早接受HBOT治疗2.4h（95％CI0.6-9.7）。广义线性混合效应模型(八项研究，126名患者）显示出HBOT时间与有利结果的概率之间的显着关系（p=0.013），在纠正严重程度后仍然显着（p=0.041）。当HBOT立即启动时，有利结果的概率从大约65%下降，当HBOT延迟15小时时，降至30%。
结论：在医源性CAGE中，HBOT时间增加与良好结局的概率降低相关。这表明在医源性CAGE中尽早启动HBOT至关重要。
方法：我们系统地研究了医源性CAGE患者的HBOT时间和预后。在组级别，我们荟萃分析了结局有利和不利患者的中位HBOT时间之间的差异.在个体患者层面上，我们在广义线性混合效应模型中分析了HBOT时间与有利结果概率之间的关系.
结果：组水平的荟萃分析（十项研究，263例患者）显示，预后良好的患者比预后不良的患者早接受HBOT治疗2.4h（95％CI0.6-9.7）。广义线性混合效应模型(八项研究，126名患者）显示出HBOT时间与有利结果的概率之间的显着关系（p=0.013），在纠正严重程度后仍然显着（p=0.041）。当HBOT立即启动时，有利结果的概率从大约65%下降，当HBOT延迟15小时时，降至30%。
结论：在医源性CAGE中，HBOT时间增加与良好结局的概率降低相关。这表明在医源性CAGE中尽早启动HBOT至关重要。
