Treatment strategies for patients with out-of-hospital cardiac arrest associated with traumatic brain injury: A case series

Hitoshi Kobata; Akira Sugie; Makiko Kawakami; Suguru Tanaka; Gemmalynn Sarapuddin; Adam Tucker

doi:10.1016/j.ajem.2024.05.006

Treatment strategies for patients with out-of-hospital cardiac arrest associated with traumatic brain injury: A case series

Am J Emerg Med. 2024 May 9:82:8-14. doi: 10.1016/j.ajem.2024.05.006. Online ahead of print.

Authors

Hitoshi Kobata¹, Akira Sugie², Makiko Kawakami³, Suguru Tanaka⁴, Gemmalynn Sarapuddin⁵, Adam Tucker⁶

Affiliations

¹ Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Department of Neurosurgery, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan; Deparment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan. Electronic address: hitoshi.kobata@ompu.ac.jp.
² Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Emergency Medical Center, Ijinkai Takeda General Hospital, 28-1 Isidamoriminamicho, Fushimiku, Kyoto, 601-1495, Japan. Electronic address: akira.sugie@ompu.ac.jp.
³ Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Department of Anesthesiology, Osaka Saiseikai Suita Hospital, 1-2 Kawazonocho, Suita, Suita, Osaka 564-0013, Japan. Electronic address: makimakinew0828@gmail.com.
⁴ Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Deparment of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigakumachi, Takatsuki, Osaka 569-8686, Japan. Electronic address: suguru.tanaka@ompu.ac.jp.
⁵ Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Neurology Department, Institute of Neurosciences, The Medical City, Ortigas Avenue, Pasig, Metro Manila, Philippines. Electronic address: gemmalynns@yahoo.com.
⁶ Osaka Mishima Emergency Critical Center, 11-1 Minami-akutagawacho, Takatsuki, Osaka 569-1124, Japan; Department of Neurosurgery, Japanese Red Cross Kitami Hospital, 2-1 Kita 6-jo, higashi, Kitami, Hokkaido 090-8666, Japan. Electronic address: taka2275@hotmail.com.

PMID: 38749373
DOI: 10.1016/j.ajem.2024.05.006

Abstract

Introduction: Collapse after out-of-hospital cardiac arrest (OHCA) can cause severe traumatic brain injury (TBI). We aimed to investigate the clinical characteristics and treatment strategies for patients with OHCA and TBI.

Methods: We analyzed a consecutive cohort of patients with intrinsic OHCA retrospectively treated between January 2011 and December 2021 at a single critical care center, and presented a case series of seven patients. Patients with collapse-related TBI were examined for the causes and situations of cardiac arrest, laboratory data, radiological images, targeted temperature management (TTM), coronary angiography (CAG), percutaneous coronary intervention (PCI), and extracorporeal cardiopulmonary resuscitation (ECPR).

Results: Of the 197 patients with intrinsic OHCA, 7 (3.6%) had TBI (age range: 49-70 years; 6 men). All seven patients presented with ventricular fibrillation in the initial electrocardiograms, with four refractory cases treated with ECPR. All patients underwent CAG under heparinization, and four underwent PCI with antiplatelet administration. Initial head computed tomography indicated an intracranial hemorrhage (ICH) in three patients. ICH appeared or was exacerbated in six patients after CAG with or without PCI, except in one who underwent delayed PCI. All patients displayed elevated plasma D-dimer levels, and four underwent neurosurgical procedures. Four patients survived (three with cerebral performance category [CPC] 2, one with CPC 3) and three died; two had hypoxic-ischemic brain injury and one had severe TBI.

Conclusion: Delayed ICH occurred frequently. Individualized management is required based on the extent of brain and cardiac damage, including optimal TTM, PCI procedures, and antiplatelet medications. Early detection of ICH and emergency treatment are critical for multi-disciplinary collaboration.

Keywords: Cardiac arrest; Extracorporeal cardiopulmonary resuscitation; Hypoxic-ischemic brain injury; Targeted temperature management; Traumatic brain injury; Treatment strategy.