Factors Associated with Favorable Response to Hyperbaric Oxygen Therapy among Patients Presenting with Iatrogenic Cerebr
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ORIGINAL ARTICLE
Factors Associated with Favorable Response to Hyperbaric Oxygen Therapy among Patients Presenting with Iatrogenic Cerebral Arterial Gas Embolism Wondwossen G. Tekle • Cheryl D. Adkinson • Saqib A. Chaudhry • Vikram Jadhav • Ameer E. Hassan Gustavo J. Rodriguez • Adnan I. Qureshi
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Published online: 7 March 2012 Ó Springer Science+Business Media, LLC 2012
Abstract Background Iatrogenic cerebral arterial gas embolism (CAGE) is an uncommon but potentially a fatal condition. Hyperbaric oxygen (HBO2) therapy is the only definitive treatment for patients with CAGE presenting with acute neurologic deficits. Methods We reviewed medical records and neuroimaging of consecutive CAGE patients treated with HBO2 at a state referral hyperbaric facility over a 22-year period. We analyzed the effect of demographics, source of intra-arterial gas, signs and symptoms, results of imaging studies, time between event and HBO2 treatment, and response to HBO2 treatment in 36 consecutive patients. Favorable outcome was defined by complete resolution or improvement of CAGE signs and symptoms at 24 h after HBO2 treatment. Unfavorable outcome was defined by unchanged or worsened neurologic signs and symptoms or in hospital death. Results A total of 26 (72%) of the 36 patients had favorable outcome. Patients with favorable outcome were younger compared to those with unfavorable outcome (mean age [years, SD] 44.7 ± 17.8 vs. 58.1 ± 24.1,
Electronic supplementary material The online version of this article (doi:10.1007/s12028-012-9683-3) contains supplementary material, which is available to authorized users. W. G. Tekle (&) S. A. Chaudhry V. Jadhav A. E. Hassan G. J. Rodriguez A. I. Qureshi Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, Minneapolis, MN 55455, USA e-mail: [email protected]; [email protected] W. G. Tekle C. D. Adkinson S. A. Chaudhry V. Jadhav A. E. Hassan G. J. Rodriguez A. I. Qureshi Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA
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p = 0.08). Cardiopulmonary symptoms were significantly more common in CAGE related to venous source of gas compared to arterial source (p = 0.024) but did not influence the rate of favorable outcomes. Adjusted multivariate analysis demonstrated that time from event to HBO2 B6 h (positively) and the presence of infarct/edema on head computerized tomography (CT)/magnetic resonance imaging (MRI) before HBO2 (negatively) were independent predictors of favorable outcome at 24 h after HBO2 treatment [odds ratio (OR) 9.08 confidence interval (CI) (1.13–72.69), p = 0.0376, and (OR) 0.034 (CI) (0.002– 0.58), p = 0.0200, respectively]. Two of the 36 patients were treated with thrombolytics because of acute focal deficits and suspected ischemia—one with intravenous and the second with intra-arterial thrombolysis. The latter patient developed fatal intracerebral hemorrhage. Conclusions A high proportion of CAGE patients treated with HBO2 had favorable out
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