Acute brain swelling after out-of-hospital cardiac arrest: pathogenesis and outcome.
OBJECTIVE
First, to examine factors that may be related to brain swelling, which was identified by the absence or compression of the lateral and third ventricles and perimesencephalic cisterns on brain computed tomography (CT) scans in the early postresuscitation period in patients who suffered an out-of-hospital cardiac arrest. Second, to characterize the neurologic outcome in those patients in whom cardiac arrest was followed by brain swelling.


METHODS
Prospective and retrospective analyses.


METHODS
General ICU, tertiary care hospital.


METHODS
Fifty-three patients (35 male, 18 female) who had an out-of-hospital cardiac arrest and who also had a brain CT examination on the third day after resuscitation. The 53 patients were divided into two groups: group A (25 patients) experienced brain swelling on postresuscitation day 3; group B (28 patients) did not experience noticeable brain swelling.


METHODS
None.


RESULTS
There was a significant difference between the two groups in the etiology of the cardiac arrest. Twenty-three of 25 patients in group A had cardiac arrest due to respiratory distress, whereas this finding was true in only five patients in group B. In laboratory data, arterial pH was significantly lower in group A than in group B (6.93 vs. 7.09), as was base deficit (-21.0 mmol/L in group A vs. -13.7 mmol/L in group B). Neurologic outcome was evaluated 1 wk after resuscitation. There were significantly more patients in group A who were not awake and who were diagnosed as brain dead.


CONCLUSIONS
The cause of brain swelling may be related to the development of the metabolic acidosis (possibly lactic acidosis) due to hypoxia before the resuscitation period. Brain swelling may be one of the indicators that predicts a poor neurologic outcome in the patients who suffer an out-of-hospital cardiac arrest.
Morimoto
Y
Y
Department of Anesthesiology and Intensive Care, Hokkaido University School of Medicine, Sapporo, Japan.
Kemmotsu
O
O
Kitami
K
K
Matsubara
I
I
Tedo
I
I
D000138:Acidosis / Q000150:complications; D000208:Acute Disease; D000328:Adult; D000368:Aged; D001929:Brain Edema / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D006323:Heart Arrest / Q000150:complications* / Q000209:etiology; D006331:Heart Diseases / Q000150:complications; D006801:Humans; D000860:Hypoxia / Q000150:complications; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012120:Respiration Disorders / Q000150:complications; D012151:Resuscitation; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome