title: The optic nerve sheath diameter as a useful tool for early prediction of outcome after cardiac arrest: A prospective pilot study.
abstract: Optic nerve sheath diameter (ONSD) measurement could detect increased intracranial pressure, and might predict outcome in post-cardiac arrest (CA) patients. We assessed the ability of bedside ONSD ultrasonographic measurement performed within day 1 after CA occurrence to predict in-hospital survival in patients treated with therapeutic hypothermia (TH).
  
  
  
  In two French ICUs, a prospective study included all consecutive patients with CA without traumatic or neurological etiology, successfully resuscitated and TH-treated. ONSD measurements were performed on day 1, 2, and 3 (ONSD1, 2, 3 respectively) after return of spontaneous circulation. All records were registered according to Utstein style.
  
  
  
  ONSD1, 2, 3 were assessed in 36, 21, and 14 patients respectively. 19/36 patients (53%) were discharged alive from hospital, including 14/36 (39%) with favorable neurological outcome (Cerebral Performance Category [CPC] score 1-2). Survivors and non-survivors were similar regarding age, sex, cardiovascular risk factors, location and etiology of CA, simplified acute physiology score II, occurrence of post-CA shock, and clinical parameters collected during ONSD measurements. Median ONSD1 was significantly larger in non-survivors versus survivors (7.2mm [interquartile: 6.8-7.4] versus 6.5mm [interquartile: 6.0-6.8]; p=0.008). After adjustment on predictive factors, ONSD1 was significantly associated with in-hospital mortality (OR 6.3; 95%CI [1.05-40] per mm of ONSD1 above 5.5mm; p=0.03), and CPC score (OR for 1 point increase in CPC score: 3.2; 95%CI [1.2-9.4] per mm of ONSD1 above 5.5mm; p=0.03). ONSD1 was significantly correlated with brain edema assessed by the cerebrum gray matter attenuation to white matter attenuation ratio, measured by the brain computed tomography scan performed on admission in 20 patients (Spearman rho=-0.5, p=0.04).
  
  
  
  ONSD seems a promising tool to early assess outcome in post-CA patients treated with TH.
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France. Electronic address: jonathan.chelly@ch-melun.fr.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Chelly
authors.affiliation: Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France; INSERM U942, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Deye
authors.affiliation: Department of Radiology, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Guichard
authors.affiliation: Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Vodovar
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Ly
authors.initials: L
authors.lastname: Vong
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Jochmans
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Thieulot-Rolin
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Oumar
authors.initials: O
authors.lastname: Sy
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Serbource-Goguel
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Christophe
authors.initials: C
authors.lastname: Vinsonneau
authors.affiliation: Medical and Toxicological Intensive Care Unit, Groupe Hospitalier Lariboisière - Saint Louis - Fernand Widal, Assistance Publique des Hôpitaux de Paris, 2 rue Ambroise Paré, 75545 Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Megarbane
authors.affiliation: SAMU 75, Hôpital Necker - Enfants Malades - Assistance Publique des Hôpitaux de Paris, 149 rue de Sèvres, 75015 Paris, France.
authors.forename: Benoit
authors.initials: B
authors.lastname: Vivien
authors.affiliation: SAMU 77, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Karim
authors.initials: K
authors.lastname: Tazarourte
authors.affiliation: Intensive Care Unit, Hôpital Marc Jacquet, 1 rue Fréteau de Pény, 77000 Melun, France.
authors.forename: Merhan
authors.initials: M
authors.lastname: Monchi
mesh_terms: D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009186:Myelin Sheath / Q000473:pathology*; D009900:Optic Nerve / Q000000981:diagnostic imaging / Q000473:pathology*; D010865:Pilot Projects; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
keywords: Cardiac arrest; Neuroprognostication; Optic nerve sheath diameter; Outcome; Ultrasonography