Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients
OBJECTIVES:. 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. DESIGN, SETTING, AND PARTICIPANTS:....
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| Format: | Article |
| Language: | English |
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Wolters Kluwer
2024-03-01
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| Series: | Critical Care Explorations |
| Online Access: | http://journals.lww.com/10.1097/CCE.0000000000001061 |
| _version_ | 1797243118474493952 |
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| author | Sydney V. Palka, MD Jenna A. Gonillo-Davis, NP Benjamin P. George, MD, MPH Daryl C. McHugh, MD, MPH |
| author_facet | Sydney V. Palka, MD Jenna A. Gonillo-Davis, NP Benjamin P. George, MD, MPH Daryl C. McHugh, MD, MPH |
| author_sort | Sydney V. Palka, MD |
| collection | DOAJ |
| description | OBJECTIVES:. 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.
DESIGN, SETTING, AND PARTICIPANTS:. 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.
MAIN OUTCOMES AND MEASURES:. 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 AND REVELANCE:. 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. |
| first_indexed | 2024-04-24T18:50:02Z |
| format | Article |
| id | doaj.art-d7e40217c9524135afb119650b819cd4 |
| institution | Directory Open Access Journal |
| issn | 2639-8028 |
| language | English |
| last_indexed | 2024-04-24T18:50:02Z |
| publishDate | 2024-03-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Critical Care Explorations |
| spelling | doaj.art-d7e40217c9524135afb119650b819cd42024-03-27T03:41:11ZengWolters KluwerCritical Care Explorations2639-80282024-03-0163e106110.1097/CCE.0000000000001061202403000-00008Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest PatientsSydney V. Palka, MD0Jenna A. Gonillo-Davis, NP1Benjamin P. George, MD, MPH2Daryl C. McHugh, MD, MPH3All authors: Department of Neurology, University of Rochester Medical Center, Rochester, NY.All authors: Department of Neurology, University of Rochester Medical Center, Rochester, NY.All authors: Department of Neurology, University of Rochester Medical Center, Rochester, NY.All authors: Department of Neurology, University of Rochester Medical Center, Rochester, NY.OBJECTIVES:. 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. DESIGN, SETTING, AND PARTICIPANTS:. 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. MAIN OUTCOMES AND MEASURES:. 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 AND REVELANCE:. 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.http://journals.lww.com/10.1097/CCE.0000000000001061 |
| spellingShingle | Sydney V. Palka, MD Jenna A. Gonillo-Davis, NP Benjamin P. George, MD, MPH Daryl C. McHugh, MD, MPH Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients Critical Care Explorations |
| title | Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients |
| title_full | Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients |
| title_fullStr | Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients |
| title_full_unstemmed | Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients |
| title_short | Spontaneous Hypothermia As an Indicator of Early Diffuse Anoxic Brain Injury in Post-Cardiac Arrest Patients |
| title_sort | spontaneous hypothermia as an indicator of early diffuse anoxic brain injury in post cardiac arrest patients |
| url | http://journals.lww.com/10.1097/CCE.0000000000001061 |
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