Few data characterize the role of brain computed tomography (CT) after resuscitation from in-hospital cardiac arrest (IHCA). We hypothesized that identifying a neurological etiology of arrest or cerebral edema on brain CT are less common after IHCA than after resuscitation from out-of-hospital cardiac arrest (OHCA). We included all patients comatose after resuscitation from IHCA or OHCA in this retrospective cohort analysis. We abstracted patient and arrest clinical characteristics, as well as pH and lactate, to estimate systemic illness severity. Brain CT characteristics included quantitative measurement of the grey-to-white ratio (GWR) at the level of the basal ganglia and qualitative assessment of sulcal and cisternal effacement. We compared GWR distribution by stratum (no edema ≥1.30, mild-to-moderate <1.30 and >1.20, severe ≤1.20) and newly identified neurological arrest etiology between IHCA and OHCA groups. We included 2,306 subjects, of whom 420 (18.2%) suffered IHCA. Fewer IHCA subjects underwent post-arrest brain CT versus OHCA subjects (149 (35.5%) vs 1,555 (82.4%), < 0.001). Cerebral edema for IHCA versus OHCA was more often absent (60.1% vs. 47.5%) or mild-to-moderate (34.3% vs. 27.9%) and less often severe (5.6% vs. 24.6%). A neurological etiology of arrest was identified on brain CT in 0.5% of IHCA versus 3.2% of OHCA. Although severe edema was less frequent in IHCA relative to OHCA, mild-to-moderate or severe edema occurred in one in three patients after IHCA. Unsuspected neurological etiologies of arrest were rarely discovered by CT scan in IHCA patients.

中文翻译：

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院内心脏骤停复苏后的脑部计算机断层扫描

很少有数据描述脑计算机断层扫描 (CT) 在院内心脏骤停 (IHCA) 复苏后的作用。我们假设，与院外心脏骤停 (OHCA) 复苏后相比，IHCA 后通过脑 CT 识别心脏骤停或脑水肿的神经学病因不太常见。在这项回顾性队列分析中，我们纳入了 IHCA 或 OHCA 复苏后昏迷的所有患者。我们提取了患者和逮捕的临床特征以及 pH 值和乳酸，以估计全身性疾病的严重程度。脑 CT 特征包括基底节水平灰白比 (GWR) 的定量测量以及脑沟和脑池消失的定性评估。我们比较了 IHCA 和 OHCA 组之间按层划分的 GWR 分布（无水肿≥1.30，轻度至中度 <1.30 和 >1.20，重度≤1.20）以及新发现的神经骤停病因。我们纳入了 2,306 名受试者，其中 420 名 (18.2%) 患有 IHCA。与 OHCA 受试者相比，IHCA 受试者在逮捕后接受脑 CT 治疗的人数较少（149 例 (35.5%) vs 1,555 例 (82.4%)，< 0.001）。与 OHCA 相比，IHCA 的脑水肿更常见（60.1% vs. 47.5%）或轻度至中度（34.3% vs. 27.9%），严重程度则较少（5.6% vs. 24.6%）。 0.5% 的 IHCA 患者与 3.2% 的 OHCA 患者通过脑部 CT 发现了逮捕的神经学病因。尽管与 OHCA 相比，IHCA 中严重水肿的发生率较低，但 IHCA 后三分之一的患者出现轻度至中度或重度水肿。 CT 扫描很少发现 IHCA 患者中未被怀疑的神经系统逮捕病因。