BACKGROUND & AIMS:
BACKGROUND:The routine application of whole-body CT after extracorporeal cardiopulmonary resuscitation (ECPR) in out-of-hospital cardiac arrest (OHCA) has not been extensively investigated. We aimed to evaluate the benefit of CT in this context.
METHODS:We retrospectively analyzed all OHCA patients who had received ECPR between January 2006 to May 2019. Electronic records were reviewed to filter out patients who had a whole-body CT as their first clinical evaluation after ECPR. CT findings and major hospital outcomes were evaluated.
RESULTS:From January 2006 to May 2019, 700 patients had received ECPR in our institution. We identified 93 OHCA patients who received whole-body CT as the first clinical evaluation after ECPR. 22.6% of those had no acute findings detected on CT requiring immediate treatment. In the remaining 77.4%, CT had findings that might lead to alterations in clinical course. Most important findings were myocardial infarction (57.0%), hypoxic brain injury (29.0%), sternal/rib fractures (16.1%), aortic dissection (7.5%), pulmonary embolism (5.4%), and cardiac tamponade (5.4%). There were no significant differences in ICU/hospitalization days, time on ECMO support, survival and neurological outcomes between those with and without immediate CT. In our OHCA cohort, there were 27 patients with CT evidence of hypoxic brain injury, of whom 22.2% (n = 2) managed to wean from ECMO support, 14.8% (n = 4) survived to discharge, but only 3.7% (n = 1) survived with good neurological outcome. Hypoxic brain injury on CT has a 95% specificity in predicting poor neurological outcome, with a false positive rate of only 3.7%. Logistic regression suggested a potential correlation between CT findings of hypoxic brain injury and poor neurological outcome [Odds ratio (OR) = 12.53 (1.55 to 10.1), p = 0.02)].
CONCLUSIONS:Routine whole-body CT after ECPR in OHCA patients appears to have a limited role, as the majority is caused by ACS. However, it may be a useful tool when CPR-related injury or non-ACS causes of OHCA are suspected, as well as in cases where the cause of OHCA is unknown. On the contrary, routine brain CT may be a valuable tool in guiding anticoagulant therapy during ECMO and in aiding outcome prediction.
背景与目标:
背景:体外循环心脏复苏(ECPR)在院外心脏骤停(OHCA)中全身CT的常规应用尚未得到广泛研究。我们旨在评估在这种情况下CT的好处。
方法:我们回顾性分析了2006年1月至2019年5月间所有接受ECPR的OHCA患者。审查了电子记录以筛选出全身CT作为ECPR后的首次临床评估的患者。评估CT表现和主要医院结局。
结果:从2006年1月到2019年5月,我们机构有700名患者接受了ECPR。我们确定了93例接受全身CT的OHCA患者,这是ECPR后的首次临床评估。 22.6%的患者未在CT上发现急性症状,需要立即治疗。在其余的77.4%中,CT的发现可能会导致临床过程的改变。最重要的发现是心肌梗塞(57.0%),低氧性脑损伤(29.0%),胸骨/肋骨骨折(16.1%),主动脉夹层(7.5%),肺栓塞(5.4%)和心脏压塞(5.4%)。有和没有立即CT的患者之间的ICU /住院天数,ECMO支持时间,生存率和神经系统结局无显着差异。在我们的OHCA队列中,有27例具有缺氧性脑损伤的CT证据,其中22.2%(n = 2)设法从ECMO支持中撤离,14.8%(n = 4)幸存了下来,但只有3.7%(n = 1)存活,神经功能良好。 CT缺氧性脑损伤在预测不良神经功能方面具有95%的特异性,假阳性率仅为3.7%。 Logistic回归表明,缺氧性脑损伤的CT表现与不良的神经系统预后之间存在潜在的相关性[几率(OR)= 12.53(1.55至10.1),p = 0.02)]。
结论:OHCA患者ECPR后常规的全身CT检查似乎作用有限,因为多数是ACS引起的。但是,当怀疑与CPR相关的损伤或OHCA的非ACS原因以及未知的OHCA原因时,它可能是有用的工具。相反,常规脑部CT可能是指导ECMO期间抗凝治疗以及帮助预测结果的有价值的工具。