目的:确定自发性低温(SH),定义为初始复苏后核心体温低于34°C,和弥漫性缺氧脑损伤(DABI)在最初的头部CT扫描(CTH)后心脏骤停患者。
方法:这是一个回顾性研究,观察性队列研究。这项研究是在罗切斯特大学医学中心斯特朗纪念医院进行的。包括2022年1月1日至2022年10月31日期间收治的所有住院和院外心脏骤停患者,这些患者恢复了自发循环。
方法:主要结果是心脏骤停后SH患者与无SH患者的初始CTH发生DABI的几率,使用多变量逻辑回归控制患者协变量,包括基本人口统计学和骤停特征。使用神经放射科医生解释并计算基底神经节的灰白质比,对初始CTH进行定性和定量测量DABI。分别。次要结果指标包括住院时间(LOS),住院死亡率,以及那些接受生命维持治疗(WOLST)或进展为脑死亡的人。
结果:在观察到的150例心脏骤停中,31例(21%)患者有SH。在最初进行CTH的128例患者中,27人(21%)患有DABI。当定性和定量测量DABI时,DABI对与SH相关的初始CTH的调整比值比为3.55(95%CI,1.08-11.64;p=0.036)和2.18(95%CI,0.69-6.91;p=0.182),分别,在控制多个协变量后。两组之间的LOS存在差异(3vs.10天;p=0.0005),这是由早期的WOLST驱动的。
结论:心脏骤停后出现SH的患者与骤停后体温较高的患者相比,在最初的CTH出现早期DABI的风险更大。早期SH的识别可能有助于DABI风险最高的心脏骤停后患者的风险分层。
OBJECTIVE: To determine the association between spontaneous hypothermia (SH), defined as initial post-resuscitation core body temperature less than 34°C, and diffuse anoxic brain injury (DABI) on initial CT scan of the head (CTH) in post-cardiac arrest patients.
METHODS: This was a retrospective, observational cohort study. This study was performed at the University of Rochester Medical Center Strong Memorial Hospital. All in-hospital and out-of-hospital cardiac arrest patients with return of spontaneous circulation admitted between January 1, 2022, and October 31, 2022, were included.
METHODS: The primary outcomes were the odds of DABI on initial CTH for patients with SH compared with patients without SH post-cardiac arrest using a multivariable logistic regression controlling for patient covariates including basic demographics and arrest features. DABI on initial CTH was measured qualitatively and quantitatively using neuroradiologist interpretation and calculated gray-white matter ratio of the basal ganglia, respectively. Secondary outcome measures included length of stay (LOS), inpatient mortality, and those who underwent withdrawal of life-sustaining therapy (WOLST) or progression to brain death.
RESULTS: Out of the observed 150 cases of cardiac arrest, 31 patients (21%) had SH. Of the 128 patients who had an initial CTH performed, 27 (21%) had DABI. The adjusted odds ratio of DABI on initial CTH associated with SH was 3.55 (95% CI, 1.08-11.64; p = 0.036) and 2.18 (95% CI, 0.69-6.91; p = 0.182) when DABI was measured qualitatively and quantitatively, respectively, after controlling for multiple covariates. There was a difference observed in LOS between the groups (3 vs. 10 d; p = 0.0005) and this was driven by early WOLST.
CONCLUSIONS: Patients presenting with SH after cardiac arrest may be at greater risk of early DABI on initial CTH compared with those with higher body temperatures in the post-arrest period. Recognition of early SH may help to risk stratify post-cardiac arrest patients at highest risk of DABI.