Duration and clinical features of cardiac arrest predict early severe cerebral edema

Abstract

Background: Severe brain edema appears early after cardiopulmonary resuscitation (CPR) in a subset of patients and portends a poor prognosis. We tested whether clinical features of patients or resuscitation during out-of-hospital cardiac arrest (OHCA) are associated with early, severe cerebral edema.Method/research design: We reviewed pre-hospital and hospital records for comatose patients surviving to hospital admission after OHCA who had computed tomography (CT) of brain at the time of hospital admission available for inspection. We measured the gray-white ratio (GWR) of X-ray attenuation between the caudate nucleus and posterior limb of the internal capsule, defining severe cerebral edema as GWR < 1.20. We calculated associations between severe cerebral edema and patient or resuscitation variables.Results: Between 2010 and 2019, 1340 subjects were admitted of whom 296 (22%) showed severe cerebral edema on initial CT. Subjects with severe edema had lower survival (5/296, 2% vs. 377/1044, 36%). Severe edema was independently associated with total CPR duration, total dose of epinephrine, younger age, non-shockable arrest rhythms, fewer total number of rescue shocks, rearrest after initial return of pulses, and non-cardiac arrest etiology.Prevalence of severe cerebral edema increased from 2% among subjects with 0À10 min of CPR to 31% among subjects with >40 min of CPR. Conclusion:CPR duration along with easily measurable clinical and resuscitation characteristics predict early severe cerebral edema after OHCA. Future interventional trials should consider targeting or preventing cerebral edema after prolonged hypoxic-ischemic brain injury especially in patients with high risk clinical features.

Clinical outcomes and safety of passive leg raising in out-of-hospital cardiac arrest: a randomized controlled trial

“…According to the results obtained, PLR during CPR is a safe intervention. The pulmonary complications rate observed in the first chest X-rays and the incidence of brain edema on CT were similar to that of other studies [30,31]. The autopsy study provides objective data on lung congestion and brain edema.…”

Brain injury after cardiac arrest

“…The chance of survival with a favourable neurological outcome declines rapidly the longer someone remains in cardiac arrest. 1 As the heart is more tolerant of ischaemia than the brain, even where initial resuscitation efforts are successful, up to 70% of those admitted to the hospital die from the effects of post-cardiac arrest brain injury. [2][3][4] The ultimate goal of resuscitation is to restore cardiac and cerebral function to that before the cardiac arrest.…”

Gray-White Matter Ratio at the Level of the Basal Ganglia as a Predictor of Neurologic Outcomes in Cardiac Arrest Survivors: A Literature Review

“…Post-CA hypoxic-ischemic brain injury is a dynamic process during which the HU of the GM decreases more quickly than that of the WM. Therefore, GWR measurements display a declining trend in a time-dependent manner ( 27 ). A recent study reported that the average first GWR-BG measurement was 1.186 ± 0.07 in poor outcome CA survivors, but this value decreased to 1.088 ± 0.143 when cranial CT was performed again during the following seven days ( 28 ).…”

“…Previous analyses have determined that the sensitivity of the GWR-BG is affected by a variety of factors, including differences in the definition of poor neurologic outcomes, the time from ROSC to CT, the GWR measurement regions, and the GWR cut-off values. In addition to CPC scores, Modified Rankin Scale (mRS) and Glasgow Outcome Scale (GOS) scores have been used to define neurological outcomes in some prior studies ( 23 , 27 , 46 ). Neurological outcomes are typically assessed during the hospital discharge process.…”