THE ROLE OF COMPUTERIZED BRAIN TOMOGRAPHY IN DETERMINING THE PROGNOSIS IN CASES WITH CARDIOPULMONARY ARREST AND RETURN OF SPONTANEOUS CIRCULATION IN THE EMERGENCY DEPARTMENT
Abstract
OBJECTIVE: We aimed to evaluate the role of computed brain tomography in determining the patient's prognosis after spontaneous circulation who were treated with cardiopulmonary arrest in the emergency department.
MATERIAL AND METHODS: We retrospectively evaluated 28 patients with cardiopulmonary arrest. Patients' demographic information, location of arrest, arrest etiology, duration of cardiopulmonary resuscitation, survival time and glasgow outcome scale, computerized brain tomography findings and time of shooting were evaluated.
RESULTS: Patients were divided into two groups according to their life expectancy: those who live less than 30 days (group 1) and those who live more than 30 days (group 2). At the end of the first month, 13 (46.43%) patients were alive. Six (46.15%) of the survivors had good neurological results. In the patients who died in the first month of the computerized brain tomography, the rate of hypodensity was low while the gray-white matter evanescence was 80% in the basal ganglion level and 100% in the upper levels. Tomography revealed hypoxia in all patients with out-of-hospital cardiac arrest and 70% of patients with in-hospital-cardiac arrest had hypoxia.
CONCLUSIONS: In addition to hypodensity on computed brain tomography following cardiac arrest, gray-white matter evanescence and levels can be estimated in terms of survival and prognosis.
References
- 1. Ruzman T, Tot OK, Ivic D, Gulam D, Ruzman N, Burazin J. In-hospital cardiac arrest: can we change something? Wiener klinische Wochenschrift The Central European Journal of Medicine. 2013;125:516–23.
- 2. Akıllı NB, Cander B, Koylu R, Dundar ZD, Ayan M. How Much Do We Know About Cardiopulmonary Resuscitation? Kardiyopulmoner Resusitasyonu Ne Kadar Biliyoruz? The Journal of Academic Emergency Medicine JAEM. 2012;11:102- 5.
- 3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association. Circulation 2015; 131:e29-322
- 4. Robin N., Elizabeth E., William J.B. Cranial Computed Tomography in the Resuscitated Patient With Cardiac Arrest. American Journal of Emergency Medicine 2009; 27:63-67.
- 5. Taccone F, Cronberg T, Friberg H, Greer D. How to assess prognosis after cardiac arrest and therapeutic hypothermia Crit Care. 2014; 18(1): 202.
- 6. D. Stub, S. Bernard, V. Pellegrino, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88-94
- 7. Sahutoglu C., Uyar M., Demirag K., Isayev H. Kardiyak Arrest Hastalarında Brain Arrest Neurological Outcome Scale (BrANOS) ile Mortalite ve Morbidite tahmini. Turk J Anaesthesiol Reanim 2016;44:295-300.
- 8. Jerry P., Nolan Jasmeet Soar Alain Cariou, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 Guidelines for Post-Resuscitation Care. Intensive Care Med (2015) 41:2039-2056.
- 9. Akahane M, Ogawa T, Koike S, Tanabe S, Horiguchi H, Mizoguchi T,et al. The effects of sex on out-of-hospital cardiac arrest outcomes. Am J Med2011;124:325-33.
- 10. Gentsch A., Storm C., Leithner C., Schroeder T. Outcome Prediction in Patients After Cardiac Arrest: A Simplified Method for Determination of Gray-White Matter Ratio in Cranial Computed Tomography. Clinical Neuroradiology (2015)25:49-54.
- 11. Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000–2009. Resuscitation; 2013;1–6.
- 12. Torbey, M.T., et al., Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke, 2000. 31(9): p. 2163-2167.
- 13. Starling, R.M., et al., Early head CT findings are associated with outcomes after pediatric out-of-hospital cardiac arrest. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2015. 16(6): p. 542.
- 14. Şahutoğlu, C., et al., Kardiyak Arrest Hastalarında Brain Arrest Neurological Outcome Scale (BrANOS) ile Mortalite ve Morbidite Tahmini. Turk J Anaesthesiol Reanim 2016; 44: 295-300
- 15. Inamasu, J., et al., Early CT signs in out-of-hospital cardiac arrest survivors: temporal profile and prognostic significance. Resuscitation, 2010. 81(5): p. 534-538.
- 16. Inamasu, J., et al., Loss of gray–white matter discrimination as an early CT sign of brain ischemia/hypoxia in victims of asphyxial cardiac arrest. Emergency radiology, 2011. 18(4): p. 295-298.
- 17. Wu, O., et al., Predicting clinical outcome in comatose cardiac arrest patients using early noncontrast computed tomography. Stroke, 2011. 42(4): p. 985-992.
- 18. Vigneron, C., et al. Gray Matter–White Matter De-Differentiation on Brain Computed Tomography Predicts Brain Death Occurrence. in Transplantation proceedings. 2016. Elsevier.
ACİL SERVİSE KARDİYOPULMONER ARREST NEDENİYLE GETİRİLEN VE SPONTAN DOLAŞIMI GERİ DÖNEN OLGULARDA ÇEKİLEN BİLGİSAYARLI BEYİN TOMOGRAFİNİN PROGNOZU BELİRLEMEDEKİ YERİ
Abstract
AMAÇ: Acil serviste kardiyopulmoner arrest nedeniyle müdahale edilen hastalarda, spontan dolaşımın sağlanması sonrası çekilen bilgisayarlı beyin tomografinin hasta prognozunu belirlemedeki yerini değerlendirmeyi amaçladık.
GEREÇ VE YÖNTEM: Çalışmamız, 28 kardiyopulmoner arrest hastası ile retrospektif olarak yapıldı. Hastaların demografik bilgileri, arrest yeri, arrest etyolojisi, kardiyopulmoner resüsitasyon süresi, sağ kalım süresi ve Glasgow Sonlanım Skalası, bilgisayarlı beyin tomografisi bulguları ve çekim zamanı değerlendirildi.
BULGULAR:Hastalar yaşam sürelerine göre 30 günün altında yaşayanlar (1. grup) ve 30 günün üzerinde yaşayanlar (2.grup) olarak iki gruba ayrıldı. 1.ayın sonunda 13 (%46.43) hasta sağ kaldı. Sağ kalan hastaların 6 (%46.15)’sı iyi nörolojik sonuca sahipti. İlk bir ay içerisinde ölen hastalarda bilgisayarlı beyin tomografide hipodansite görülme oranı düşük iken gri-beyaz cevher silinmesi görülme oranı bazal ganglion düzeyinde %80 ve daha üst seviyelerde %100’dü. Hastane dışı arrest olan hastaların tümünde tomografide hipoksi bulgusu saptanırken hastane içinde arrest olan hastaların %70’inde hipoksi bulgusu vardı.
SONUÇ: Kardiyak arrest sonrası bilgisayarlı beyin tomografide görülen hipodansiteye ek olarak gri-beyaz cevher silinmesi ve seviyeleri değerlendirildiğinde sağ kalım ve prognoz açısından tahmin yapılabilir.
References
- 1. Ruzman T, Tot OK, Ivic D, Gulam D, Ruzman N, Burazin J. In-hospital cardiac arrest: can we change something? Wiener klinische Wochenschrift The Central European Journal of Medicine. 2013;125:516–23.
- 2. Akıllı NB, Cander B, Koylu R, Dundar ZD, Ayan M. How Much Do We Know About Cardiopulmonary Resuscitation? Kardiyopulmoner Resusitasyonu Ne Kadar Biliyoruz? The Journal of Academic Emergency Medicine JAEM. 2012;11:102- 5.
- 3. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, et al. Heart Disease and Stroke Statistics-2015 Update A Report From the American Heart Association. Circulation 2015; 131:e29-322
- 4. Robin N., Elizabeth E., William J.B. Cranial Computed Tomography in the Resuscitated Patient With Cardiac Arrest. American Journal of Emergency Medicine 2009; 27:63-67.
- 5. Taccone F, Cronberg T, Friberg H, Greer D. How to assess prognosis after cardiac arrest and therapeutic hypothermia Crit Care. 2014; 18(1): 202.
- 6. D. Stub, S. Bernard, V. Pellegrino, et al. Refractory cardiac arrest treated with mechanical CPR, hypothermia, ECMO and early reperfusion (the CHEER trial). Resuscitation. 2015;86:88-94
- 7. Sahutoglu C., Uyar M., Demirag K., Isayev H. Kardiyak Arrest Hastalarında Brain Arrest Neurological Outcome Scale (BrANOS) ile Mortalite ve Morbidite tahmini. Turk J Anaesthesiol Reanim 2016;44:295-300.
- 8. Jerry P., Nolan Jasmeet Soar Alain Cariou, et al. European Resuscitation Council and European Society of Intensive Care Medicine 2015 Guidelines for Post-Resuscitation Care. Intensive Care Med (2015) 41:2039-2056.
- 9. Akahane M, Ogawa T, Koike S, Tanabe S, Horiguchi H, Mizoguchi T,et al. The effects of sex on out-of-hospital cardiac arrest outcomes. Am J Med2011;124:325-33.
- 10. Gentsch A., Storm C., Leithner C., Schroeder T. Outcome Prediction in Patients After Cardiac Arrest: A Simplified Method for Determination of Gray-White Matter Ratio in Cranial Computed Tomography. Clinical Neuroradiology (2015)25:49-54.
- 11. Kazaure HS, Roman SA, Sosa JA. Epidemiology and outcomes of in-hospital cardiopulmonary resuscitation in the United States, 2000–2009. Resuscitation; 2013;1–6.
- 12. Torbey, M.T., et al., Quantitative analysis of the loss of distinction between gray and white matter in comatose patients after cardiac arrest. Stroke, 2000. 31(9): p. 2163-2167.
- 13. Starling, R.M., et al., Early head CT findings are associated with outcomes after pediatric out-of-hospital cardiac arrest. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies, 2015. 16(6): p. 542.
- 14. Şahutoğlu, C., et al., Kardiyak Arrest Hastalarında Brain Arrest Neurological Outcome Scale (BrANOS) ile Mortalite ve Morbidite Tahmini. Turk J Anaesthesiol Reanim 2016; 44: 295-300
- 15. Inamasu, J., et al., Early CT signs in out-of-hospital cardiac arrest survivors: temporal profile and prognostic significance. Resuscitation, 2010. 81(5): p. 534-538.
- 16. Inamasu, J., et al., Loss of gray–white matter discrimination as an early CT sign of brain ischemia/hypoxia in victims of asphyxial cardiac arrest. Emergency radiology, 2011. 18(4): p. 295-298.
- 17. Wu, O., et al., Predicting clinical outcome in comatose cardiac arrest patients using early noncontrast computed tomography. Stroke, 2011. 42(4): p. 985-992.
- 18. Vigneron, C., et al. Gray Matter–White Matter De-Differentiation on Brain Computed Tomography Predicts Brain Death Occurrence. in Transplantation proceedings. 2016. Elsevier.
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Clinical Sciences |
| Journal Section | Articles |
| Authors | |
| Publication Date | May 11, 2020 |
| Acceptance Date | November 1, 2019 |
| Published in Issue | Year 2020 Volume: 21 Issue: 2 |
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