Changshin Kang1, Jin Hong Min1, Jung Soo Park2, Yeonho You1, Insool Yoo3, Yong Chul Cho1, Wonjoon Jeong1, Hong Joon Ahn1, Seung Ryu1, Jinwoong Lee1, Seung Whan Kim1, Sung Uk Cho1, Se Kwang Oh1, In Ho Lee4, Byungkook Lee5, Donghun Lee5, Minjung Kathy Chae6. 1. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea. 2. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea. Electronic address: cpcr@cnu.ac.kr. 3. Department of Emergency Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Emergency Medicine, College of Medicine, Chungnam National University, Daejeon, Republic of Korea. 4. Department of Radiology, Chungnam National University Hospital, Daejeon, Republic of Korea; Department of Radiology, College of Medicine, Chungnam National University, Daejeon, Republic of Korea. 5. Department of Emergency Medicine, Chonnam National University Medical School, 160, Beakseo-ro, Dong-gu, Gwangju 61469, Korea. 6. Department of Emergency Medicine, Ajou University Hospital, Ajou University School of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon, Republic of Korea.
Abstract
AIM: Studies on the prognostic performance of optic nerve sheath diameter (ONSD) in out-of-hospital cardiac arrest survivors (OHCA) have reported conflicting results. We aimed to investigate the usefulness of ONSD measured using magnetic resonance imaging (MRI) to estimate its association with intracranial pressure (ICP) and 6-month neurological outcomes in CA survivors treated with targeted temperature management (TTM). METHOD: This retrospective study included 37 CA survivors who underwent TTM from January 2018 to December 2018. ICP was measured by lumbar catheter during TTM on Days 0, 1, 2, and 3. ONSD was measured using MRI on Days 0 and 3. The primary outcome was the correlation between ONSD and ICP associated with neurological outcomes obtained after 6 months. RESULTS: The median (interquartile range [IQR]) ONSD was not significantly different between the good and poor neurological outcome group on Day 0 (5.2 mm [4.8-5.8] vs 5.2 mm [4.8-5.6]; p = 0.948) and Day 3 (5.0 mm [4.8-5.2] vs 5.5 mm [4.4-5.9]; p = 0.105). ONSD and ICP had excellent correlation on Day 3 (r = 0.90, p < 0.001). ONSD showed excellent correlation with increased ICP (IICP) defined as ICP above 20 mmHg (r = 0.89, p < 0.001). ONSD cut-off of 5.99 mm was used with a sensitivity of 90.0% and specificity of 98.0% to identify IICP. CONCLUSION: The ONSD on Days 0 or 3 did not show differences in neurological outcomes in OHCA patients treated with TTM. However, ONSD had an excellent correlation with ICP on Day 3 and with IICP. Further studies are required to confirm our results.
AIM: Studies on the prognostic performance of optic nerve sheath diameter (ONSD) in out-of-hospital cardiac arrest survivors (OHCA) have reported conflicting results. We aimed to investigate the usefulness of ONSD measured using magnetic resonance imaging (MRI) to estimate its association with intracranial pressure (ICP) and 6-month neurological outcomes in CA survivors treated with targeted temperature management (TTM). METHOD: This retrospective study included 37 CA survivors who underwent TTM from January 2018 to December 2018. ICP was measured by lumbar catheter during TTM on Days 0, 1, 2, and 3. ONSD was measured using MRI on Days 0 and 3. The primary outcome was the correlation between ONSD and ICP associated with neurological outcomes obtained after 6 months. RESULTS: The median (interquartile range [IQR]) ONSD was not significantly different between the good and poor neurological outcome group on Day 0 (5.2 mm [4.8-5.8] vs 5.2 mm [4.8-5.6]; p = 0.948) and Day 3 (5.0 mm [4.8-5.2] vs 5.5 mm [4.4-5.9]; p = 0.105). ONSD and ICP had excellent correlation on Day 3 (r = 0.90, p < 0.001). ONSD showed excellent correlation with increased ICP (IICP) defined as ICP above 20 mmHg (r = 0.89, p < 0.001). ONSD cut-off of 5.99 mm was used with a sensitivity of 90.0% and specificity of 98.0% to identify IICP. CONCLUSION: The ONSD on Days 0 or 3 did not show differences in neurological outcomes in OHCA patients treated with TTM. However, ONSD had an excellent correlation with ICP on Day 3 and with IICP. Further studies are required to confirm our results.
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