基于回顾性多中心队列研究的院外心脏骤停患者超早期弥散加权MRI的最佳时机-动脉网

Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study

Nature 等信源发布 2024-10-25 14:23



可切换为仅中文







AbstractDiffusion-weighted magnetic resonance imaging (DW-MRI) performed before target temperature management, within 6 h of return of spontaneous circulation (ROSC), is defined as ultra-early DW-MRI. In previous studies, high-signal intensity (HSI) on ultra-early DW-MRI can predict poor neurological outcomes (Cerebral Performance Category 3–5 at 6-months post-ROSC).

摘要在目标温度管理之前，在自发循环恢复（ROSC）后6小时内进行的扩散加权磁共振成像（DW-MRI）被定义为超早期DW-MRI。在以前的研究中，超早期DW-MRI上的高信号强度（HSI）可以预测神经系统预后不良（ROSC后6个月的大脑表现类别3-5）。

We aimed to assess the optimal-timing for ultra-early DW-MRI to avoid false-negative outcomes post out-of-hospital cardiac arrest, considering cardiopulmonary resuscitation (CPR) factors. The primary outcomes were HSI in the cerebral cortex or deep gray matter on ultra-early DW-MRI. The impact of CPR factors and ROSC to DW-MRI scan-interval on HSI-presence was assessed.

考虑到心肺复苏（CPR）因素，我们旨在评估超早期DW-MRI的最佳时机，以避免院外心脏骤停后的假阴性结果。主要结果是超早期DW-MRI上大脑皮层或深部灰质的HSI。评估CPR因素和ROSC至DW-MRI扫描间隔对HSI存在的影响。

Of 206 included patients, 108 exhibited HSI-presence, exclusively associated with poor neurological outcomes. In multivariate regression analysis, ROSC to DW-MRI scan-interval (adjusted odds ratio [aOR], 1.509; 95% confidence interval (CI): 1.113–2.046; P = 0.008), low-flow time (aOR, 1.176; 95%CI: 1.121–1.233; P < 0.001), and non-shockable rhythm (aOR, 9.974; 95%CI: 3.363–29.578; P < 0.001) were independently associated with HSI-presence.

在206名纳入患者中，108名表现出HSI存在，仅与神经系统预后不良有关。在多变量回归分析中，ROSC至DW-MRI扫描间隔（校正比值比[aOR]，1.509；95%置信区间（CI）：1.113-2.046；P=0.008），低流量时间（aOR，1.176；95%CI:1.121-1.233；P<0.001）和非休克节律（aOR，9.974；95%CI:3.363-29.578；P<0.001）与HSI存在独立相关。

ROSC to DW-MRI scan-interval cutoff of ≥ 2.2 h was particularly significant in low-flow time ≤ 21 min or shockable rhythm group. In conclusion, short low-flow time and shockable rhythm require a longer ROSC to DW-MRI scan-interval. Prolonged low-flow time and non-shockable rhythm reduce the need to consider scan-interval..

。总之，短的低流量时间和可休克的节律需要更长的ROSC到DW-MRI扫描间隔。延长的低流量时间和不可电击的节奏减少了考虑扫描间隔的需要。。

IntroductionAdvancements in cardiopulmonary resuscitation (CPR) and critical care medicine have increased the survival rate of patients with out-of-hospital cardiac arrest (OHCA)1,2,3,4. However, several OHCA patients develop hypoxic–ischemic brain injury (HIBI), resulting in comatose conditions for extended periods5,6,7,8.

引言心肺复苏（CPR）和重症监护医学的进步提高了院外心脏骤停（OHCA）患者的生存率1,2,3,4。然而，一些OHCA患者发生缺氧缺血性脑损伤（HIBI），导致昏迷状态延长5,6,7,8。

Therefore, early determination of the degree of HIBI is crucial for providing appropriate post-resuscitation therapy and counseling to family members6,7,8,9. International guidelines advocate a 72-h delay in neurological prognostication after the return of spontaneous circulation (ROSC)10. An early and accurate prediction of neurological outcomes is important to allocate medical resources appropriately and avoid premature withdrawal of life-sustaining treatment (WLST) for OHCA patients who have the potential for neurological recovery11,12,13.In a previous study, diffusion-weighted magnetic resonance imaging (DW-MRI), performed before target temperature management (TTM), within 6 h of ROSC, was defined as ultra-early DW-MRI14,15.

因此，早期确定HIBI程度对于为家庭成员提供适当的复苏后治疗和咨询至关重要6,7,8,9。国际指南提倡在自发循环恢复（ROSC）10后神经系统预后延迟72小时。早期准确地预测神经系统结局对于适当分配医疗资源并避免过早停止具有神经系统恢复潜力的OHCA患者的维持生命治疗（WLST）非常重要11,12,13。在之前的一项研究中，扩散加权磁共振成像（DW-MRI），在目标温度管理（TTM）之前，在ROSC的6小时内进行，被定义为超早期DW-MRI14,15。

A high-signal intensity (HSI) (“restricted diffusion”) in the cerebral cortex or deep gray matter on ultra-early DW-MRI indicates irreversible progression to severe HIBI, regardless of its location and extent14,15,16,17. HIBI may occur at the time of the insult; however, damage may also continue after ROSC and oxygenation are re-established18.

超早期DW-MRI上大脑皮层或深部灰质的高信号强度（HSI）（“限制性扩散”）表明，无论其位置和范围如何，都不可逆地发展为严重的HIBI 14,15,16,17。HIBI可能发生在侮辱时；然而，在重新建立ROSC和氧合后，损伤也可能继续18。

However, HSIs on ultra-early DW-MRI is not consistently observed in patients with poor neurological outcomes due to its time-dependent nature14,15,16,17. Furthermore, HSIs on ultra-early DW-MRI is influenced by factors including the severity, duration, and progression of oxygen deprivation, as well as the absence of blood supply18,19,20,21,22,23,24,25.We hypothesized that certain clinic.

然而，由于其时间依赖性，超早期DW-MRI上的HSI在神经功能不良的患者中并不一致[14,15,16,17]。此外，超早期DW-MRI上的HSI受缺氧的严重程度，持续时间和进展以及缺乏血液供应等因素的影响18,19,20,21,22,23,24,25。我们假设某些临床。

Data availability

数据可用性

Anonymized data not published in this article can be made available upon reasonable request from any qualified investigator, subject to approval from the CNUSH, CNUH, and CBNUH Institutional Review Board. The data supporting the findings of this study can be requested from the corresponding author, Jin Hong Min, at laphir@cnu.ac.kr..

经CNUSH，CNUH和CBNUH机构审查委员会的批准，可根据任何合格调查员的合理要求提供本文中未发布的匿名数据。支持这项研究结果的数据可以向通讯作者金红民索取laphir@cnu.ac.kr..

ReferencesBenjamin, E. J. et al. Heart disease and stroke statistics-2018 update: A report from the American Heart Association. Circulation 137, e67–e492 (2018).Article

参考文献Benjamin，E.J.等人，《心脏病和中风统计-2018年更新：美国心脏协会的报告》。发行量137，e67–e492（2018）。文章

PubMed

Google Scholar

谷歌学者

Hypothermia after cardiac arrest study group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N. Engl. J. Med. 346, 549–556 (2002).Article

心脏骤停后低温研究组。轻度治疗性低温可改善心脏骤停后的神经系统结局。N、。J、。文章

Google Scholar

谷歌学者

Bernard, S. A. et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N. Engl. J. Med. 346, 557–563 (2002).Article

Bernard，S.A.等人。用诱导性低温治疗院外心脏骤停昏迷幸存者。N、。J、医学杂志346557-563（2002）。文章

PubMed

Google Scholar

谷歌学者

Nielsen, N. et al. Targeted temperature management at 33 ºC versus 36 ºC after cardiac arrest. N. Engl. J. Med. 369, 2197–2206 (2013).Article

Nielsen，N.等人在心脏骤停后将温度管理目标定为33ºC与36ºC。N、。J、医学3692197-2206（2013）。文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Sekhon, M. S., Ainslie, P. N. & Griesdale, D. E. Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: A two-hit model. Crit. Care 21, 90 (2017).Article

Sekhon，M.S.，Ainslie，P.N。和Griesdale，D.E。心脏骤停后缺氧缺血性脑损伤的临床病理生理学：两次打击模型。暴击。Care 21,90（2017）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Rossetti, A. O., Rabinstein, A. A. & Oddo, M. Neurological prognostication of outcome in patients in coma after cardiac arrest. Lancet Neurol. 15, 597–609 (2016).Article

Rossetti，A.O.，Rabinstein，A.A。＆Oddo，M。心脏骤停后昏迷患者预后的神经系统预测。柳叶刀神经学。15597-609（2016）。文章

PubMed

Google Scholar

谷歌学者

Sandron, C., D’Arrigo, S. & Nolan, J. P. Prognostication after cardiac arrest. Crit. Care. 22, 150 (2018).Article

Sandron，C.，D'Arrigo，S。＆Nolan，J.P。心脏骤停后的预后。暴击。小心。22150（2018）。文章

Google Scholar

谷歌学者

Geocadin, R. G. et al. Standards for studies of neurological prognostication in Comatose survivors of Cardiac arrest: A scientific statement from the American Heart Association. Circulation 140, e517–e542 (2019).Article

Geocadin，R.G.等人，《心脏骤停昏迷幸存者神经系统预后研究标准：美国心脏协会的科学声明》。发行量140，e517–e542（2019）。文章

PubMed

Google Scholar

谷歌学者

Dragancea, I. et al. Protocol-driven neurological prognostication and withdrawal of life-sustaining therapy after cardiac arrest and targeted temperature management. Resuscitation. 117, 50–57 (2017).Article

Dragancea，I。等人。协议驱动的神经系统预后和心脏骤停和靶向温度管理后停止维持生命的治疗。复苏。117,50-57（2017）。文章

PubMed

Google Scholar

谷歌学者

Nolan, J. P. et al. European Resuscitation Council and European Society of Intensive Care Medicine guidelines 2021: Post-resuscitation care. Intensive Care Med. 47, 369–421 (2021).Article

Nolan，J.P.等人，《欧洲复苏委员会和欧洲重症监护医学学会指南2021：复苏后护理》。重症监护医学47369-421（2021）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Elmer, J. et al. Association of early withdrawal of life-sustaining therapy for perceived neurological prognosis with mortality after cardiac arrest. Resuscitation. 102, 127–135 (2016).Article

Elmer，J.等人。早期停止维持生命治疗对感知神经预后与心脏骤停后死亡率的关联。复苏。102127-135（2016）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Grossestreuer, A. V. et al. Factors associated with post-arrest withdrawal of life-sustaining therapy. Resuscitation. 110, 114–119 (2017).Article

。复苏。110114-119（2017）。文章

PubMed

Google Scholar

谷歌学者

Lee, B. K., Min, J. H., Park, J. S., Kang, C. & Lee, B. K. Early identified risk factors and their predictive performance of brain death in out-of-hospital cardiac arrest survivors. Am. J. Emerg. Med. 56, 117–123 (2022).Article

Lee，B.K.，Min，J.H.，Park，J.S.，Kang，C。＆Lee，B.K。早期确定了院外心脏骤停幸存者脑死亡的危险因素及其预测表现。《美国急诊医学杂志》56117-123（2022）。文章

PubMed

Google Scholar

谷歌学者

Park, J. S. et al. Ultra-early neurologic outcome prediction of out-of-hospital cardiac arrest survivors using combined diffusion-weighted imaging findings and quantitative analysis of apparent diffusion coefficient. Resuscitation 148, 39–48 (2020).Article

。复苏148,39-48（2020）。文章

PubMed

Google Scholar

谷歌学者

Kang, C. S. et al. Association of ultra-early diffusion-weighted magnetic resonance imaging with neurological outcomes after out-of-hospital cardiac arrest. Crit. Care 27, 16 (2023).Article

Kang，C.S.等人。院外心脏骤停后超早期扩散加权磁共振成像与神经功能结果的关联。暴击。护理27,16（2023）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Park, J. S. et al. Efficacy of diffusion-weighted magnetic resonance imaging performed before therapeutic hypothermia in predicting clinical outcome in comatose cardiopulmonary arrest survivors. Resuscitation 88, 132–137 (2015).Article

Park，J.S.等人。在治疗性低温之前进行的扩散加权磁共振成像在预测昏迷的心肺骤停幸存者的临床结果方面的功效。复苏88132-137（2015）。文章

PubMed

Google Scholar

谷歌学者

Jeon, C. H. et al. Comparison of brain computed tomography and diffusion-weighted magnetic resonance imaging to predict early neurologic outcome before target temperature management comatose cardiac arrest survivors. Resuscitation 118, 21–26 (2017).Article

Jeon，C.H.等人。比较脑计算机断层扫描和扩散加权磁共振成像预测目标温度管理昏迷心脏骤停幸存者之前的早期神经系统结局。复苏118,21-26（2017）。文章

PubMed

Google Scholar

谷歌学者

Busl, K. M. & Greer, D. M. Hypoxic-ischemic brain injury: Pathophysiology, neuropathology and mechanisms. NeuroRehabilitation 26, 5–13 (2010).Article

Busl，K.M。＆Greer，D.M。缺氧缺血性脑损伤：病理生理学，神经病理学和机制。神经康复26,5-13（2010）。文章

PubMed

Google Scholar

谷歌学者

Welbourn, C. & Efstathiou, N. How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review. Scand. J. Trauma. Resusc. Emerg. Med. 26, 77 (2018).Article

Welbourn，C。＆Efstathiou，N。心肺复苏的时间长短如何影响心脏骤停患者的脑损伤？系统评价。斯堪的纳维亚。J、创伤。结果。《急诊医学》26,77（2018）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Coppler, P. J. et al. Duration of cardiopulmonary resuscitation and phenotype of post-cardiac arrest brain injury. Resuscitation 188, 109823 (2023).Article

Coppler，P.J.等人。心肺复苏的持续时间和心脏骤停后脑损伤的表型。复苏188109823（2023）。文章

PubMed

Google Scholar

谷歌学者

Otani, T. et al. Low-flow time is associated with a favorable neurological outcome in out-of-hospital cardiac arrest patients resuscitated with extracorporeal cardiopulmonary resuscitation. J. Crit. Care 48, 15–20 (2018).Article

Otani，T。等人。低流量时间与体外心肺复苏复苏的院外心脏骤停患者的神经功能预后良好有关。J、《致命护理》48,15-20（2018）。文章

PubMed

Google Scholar

谷歌学者

Tateishi, K. et al. Prehospital predicting factors using a decision tree model for patients with witnessed out-of-hospital cardiac arrest and an initial shockable rhythm. Sci. Rep. 13, 16180 (2023).Article

。。代表1316180（2023）。文章

ADS

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Lee, S. Y., Hwang, S. S., Park, J. H., Song, K. J. & Shin, S. D. Impact of awareness time interval on the effect of bystander cardiopulmonary resuscitation on out-of-hospital cardiac arrest: A nationwide study. Yonsei Med. J. 64, 327–335 (2023).Article

Lee，S.Y.，Hwang，S.S.，Park，J.H.，Song，K.J。＆Shin，S.D。意识时间间隔对旁观者心肺复苏对院外心脏骤停影响的影响：一项全国性研究。延世医学杂志64327-335（2023）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Han, K. S., Lee, S. W., Lee, E. J., Kwak, M. H. & Kim, S. J. Association between shockable rhythm conversion and outcomes in patients with out-of-hospital cardiac arrest and initial non-shockable rhythm, according to the cause of cardiac arrest. Resuscitation 142, 144–152 (2019).Article .

。复苏142144-152（2019）。文章。

PubMed

Google Scholar

谷歌学者

Funada, A., Goto, Y., Okada, H., Maeda, T. & Takamura, M. Effects of witness status and time to cardiopulmonary resuscitation by emergency medical services on neurological outcomes in out-of-hospital cardiac arrest patients with non-shockable rhythm. Eur. Heart J. 40(Suppl_1), ehz7460075 (2019).Article .

Funada，A.，Goto，Y.，Okada，H.，Maeda，T。＆Takamura，M。紧急医疗服务对心肺复苏的见证状态和时间对院外心脏骤停患者非休克节律的神经结局的影响。《欧洲心脏杂志》40（增刊1），ehz7460075（2019）。文章。

Google Scholar

谷歌学者

Rittenberger, J. C., Raina, K., Holm, M. B., Kim, Y. J. & Callaway, C. W. Association between cerebral performance category, modified Rankin scale, and discharge disposition after cardiac arrest. Resuscitation 82, 1036–1040 (2011).Article

Rittenberger，J.C.，Raina，K.，Holm，M.B.，Kim，Y.J。＆Callaway，C.W。大脑表现类别，改良Rankin量表与心脏骤停后出院处置之间的关联。。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Adams, R. J. et al. Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: A scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association.

Adams，R.J.等人，《短暂性脑缺血发作和缺血性卒中患者的冠状动脉风险评估：美国心脏协会/美国卒中协会卒中委员会和临床心脏病学委员会针对医疗保健专业人员的科学声明》。

Circulation 9, 1278–1290 (2003).Article .

发行量91278–1290（2003）。文章。

Google Scholar

谷歌学者

Benghanem, S. et al. Brainstem dysfunction in critically ill patients. Crit. Care 24, 5 (2020).Article

。暴击。护理24,5（2020）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Pai, V., Sitoh, Y. Y. & Purohit, B. Gyriform restricted diffusion in adults: looking beyond thrombo-occlusions. Insights Imaging 11, 20 (2020).Article

Pai，V.，Sitoh，Y。Y。和Purohit，B。成人回旋状限制扩散：超越血栓闭塞。Insights Imaging 11,20（2020）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Howard, R. S. et al. Hypoxic-ischaemic brain injury: Imaging and neurophysiology abnormalities related to outcome. QJM 105, 551–561 (2012).Article

Howard，R.S.等人，《缺氧缺血性脑损伤：与预后相关的影像学和神经生理学异常》。QJM 105551–561（2012）。文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Park, J. Y. et al. Association between the extent of diffusion restriction on brain diffusion-weighted imaging and neurological outcomes after an out-of-hospital cardiac arrest. Resuscitation 187, 109761 (2023).Article

Park，J.Y.等人。院外心脏骤停后脑扩散加权成像扩散限制程度与神经学结局之间的关联。复苏187109761（2023）。文章

PubMed

Google Scholar

谷歌学者

Oren, N. C., Chang, E., Yang, C. W. & Lee, S. K. Brain diffusion imaging findings may predict clinical outcome after cardiac arrest. J. Neuroimaging 29, 540–547 (2019).Article

Oren，N.C.，Chang，E.，Yang，C.W.＆Lee，S.K。脑扩散成像结果可能预测心脏骤停后的临床结果。J、神经影像学29540-547（2019）。文章

PubMed

Google Scholar

谷歌学者

Els, T., Kassubek, J., Kubalek, R. & Klisch, J. Diffusion-weighted MRI during early global cerebral hypoxia: A predictor for clinical outcome?. Acta Neurol. Scand. 110, 361–367 (2004).Article

Els，T.，Kassubek，J.，Kubalek，R。＆Klisch，J。早期全球脑缺氧期间的扩散加权MRI：临床结果的预测因子？。神经学报。斯堪的纳维亚。110361-367（2004）。文章

PubMed

Google Scholar

谷歌学者

Endisch, C. et al. Hypoxic-ischemic encephalopathy evaluated by brain autopsy and neuroprognostication after cardiac arrest. JAMA Neurol. 77, 1430–1439 (2020).Article

Endisch，C。等人。通过心脏骤停后脑尸检和神经预后评估缺氧缺血性脑病。JAMA Neurol。771430-1439（2020）。文章

PubMed

Google Scholar

谷歌学者

Shono, K. et al. Optimal timing of diffusion-weighted imaging to avoid false-negative findings in patients with transient ischemic attack. Stroke 48, 1990–1992 (2017).Article

Shono，K。等人。扩散加权成像的最佳时机，以避免短暂性脑缺血发作患者的假阴性结果。中风481990-1992（2017）。文章

PubMed

Google Scholar

谷歌学者

Ahlhelm, F., Schneider, G., Backens, M., Reith, W. & Hagen, T. Time course of the apparent diffusion coefficient after cerebral infarction. Eur. Radiol. 12, 2322–2329 (2002).Article

Ahlhelm，F.，Schneider，G.，Backens，M.，Reith，W。＆Hagen，T。脑梗死后表观扩散系数的时间过程。欧洲放射性。122322-2329（2002）。文章

CAS

中科院

PubMed

Google Scholar

谷歌学者

Soul, J. S., Robertson, R. L., Tzika, A. A., Plessis, A. J. & du Volpe, J. J. Time course of changes in diffusion-weighted magnetic resonance imaging in a case of neonatal encephalopathy with defined onset and duration of hypoxic-ischemic insult. Pediatrics 108, 1211–1214 (2001).Jin, O.

Soul，J.S.，Robertson，R.L.，Tzika，A.A.，Plessis，A.J。＆du Volpe，J.J。新生儿脑病的扩散加权磁共振成像变化的时间过程，定义了缺氧缺血性损伤的发作和持续时间。儿科1081211-1214（2001）。金，O。

K. & Soo, J. L. Early false-negative diffusion-weighted image in acute ischemic stroke presenting sudden isolated vertigo. J. Neurosonol. Neuroimag 10, 169–171 (2018).Article .

K、＆Soo，J.L。急性缺血性卒中的早期假阴性扩散加权图像呈现突然的孤立性眩晕。J、神经甾醇。Neuroimag 10169-171（2018）。文章。

Google Scholar

谷歌学者

Schönfeld, M. H. et al. Improved detectability of acute and subacute brainstem infarctions by combining standard axial and thin-sliced sagittal DWI. PloS One 13, e0200092 (2018).Article

Schönfeld，M.H.等人通过结合标准轴向和薄层矢状DWI提高了急性和亚急性脑干梗塞的可检测性。PloS One 13，e02000092（2018）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Park, S. et al. Optimal cardiopulmonary resuscitation duration for favorable neurological outcomes after out-of-hospital cardiac arrest. Scand. J. Trauma. Resusc. Emerg. Med. 30, 5 (2022).Article

Park，S.等人。院外心脏骤停后良好神经功能预后的最佳心肺复苏持续时间。斯堪的纳维亚。J、创伤。结果。《急诊医学》30，5（2022）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Goto, Y., Funada, A., Maeda, T. & Goto, Y. Termination-of-resuscitation rule in the emergency department for patients with refractory out-of-hospital cardiac arrest: A nationwide, population-based observational study. Crit. Care 26, 137 (2022).Article

Goto，Y.，Funada，A.，Maeda，T。＆Goto，Y。急诊科难治性院外心脏骤停患者复苏规则的终止：一项全国性的基于人群的观察性研究。暴击。。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Okada, Y. et al. Association between low pH and unfavorable neurological outcome among out-of-hospital cardiac arrest patients treated by extracorporeal CPR: A prospective observational cohort study in Japan. J. Intensive Care 8, 34 (2020).Article

Okada，Y.等人。体外心肺复苏术治疗的院外心脏骤停患者低pH值与不良神经结局之间的关系：日本的一项前瞻性观察性队列研究。J、重症监护8,34（2020）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Mutter, E. L. & Abella, B. S. Duration of cardiac arrest resuscitation: Deciding when to call the code. Circulation 133, 1338–1340 (2016).Article

Mutter，E.L。和Abella，B.S。心脏骤停复苏的持续时间：决定何时调用代码。发行量1331338–1340（2016）。文章

PubMed

Google Scholar

谷歌学者

Matsuyama, T., Ohta, B., Kiyohara, K. & Kitamura, T. Cardiopulmonary resuscitation duration and favorable neurological outcome after out-of-hospital cardiac arrest: A nationwide multicenter observational study in Japan (the JAAM-OHCA registry). Crit. Care 26, 120 (2022).Article

Matsuyama，T.，Ohta，B.，Kiyohara，K。＆Kitamura，T。院外心脏骤停后的心肺复苏持续时间和良好的神经功能结果：日本全国多中心观察性研究（JAAM-OHCA登记处）。暴击。Care 26120（2022）。文章

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Krammel, M. et al. The impact of a high-quality basic life support police-based first responder system on outcome after out-of-hospital cardiac arrest. PloS One 15, e0233966 (2020).Article

Krammel，M.等人。基于警察的高质量基本生命支持急救系统对院外心脏骤停后结局的影响。PloS One 15，e0233966（2020）。文章

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Honarmand, K., Mepham, C., Ainsworth, C. & Khalid, Z. Adherence to advanced cardiovascular life support (ACLS) guidelines during in-hospital cardiac arrest is associated with improved outcomes. Resuscitation 129, 76–81 (2018).Article

Honarmand，K.，Mepham，C.，Ainsworth，C。＆Khalid，Z。在院内心脏骤停期间遵守先进的心血管生命支持（ACLS）指南与改善预后相关。复苏129,76-81（2018）。文章

PubMed

Google Scholar

谷歌学者

Simmons, K. M., McIsaac, S. M. & Ohle, R. Impact of community-based interventions on out-of-hospital cardiac arrest outcomes: A systematic review and meta-analysis. Sci. Rep. 13, 10231 (2023).Article

Simmons，K.M.，McIsaac，S.M。＆Ohle，R。基于社区的干预对院外心脏骤停结局的影响：系统评价和荟萃分析。。代表1310231（2023）。文章

ADS

CAS

中科院

PubMed

PubMed Central

公共医学中心

Google Scholar

谷歌学者

Wood, R., Bassett, K. 5th, Spry, C. & Tong, L. 1.5 tesla magnetic resonance imaging scanners compared with 3.0 tesla magnetic resonance imaging scanners: Systematic review of clinical effectiveness. CADTH Technol Overv. 2, e2201 (2012).Download referencesFundingThis work was supported by the research fund by the National Research Foundation of Korea grant funded by the government (MIST) (No.

Wood，R.，Bassett，K。5th，Spry，C。＆Tong，L。1.5特斯拉磁共振成像扫描仪与3.0特斯拉磁共振成像扫描仪的比较：临床有效性的系统评价。。2，e2201（2012）。下载参考文献资助这项工作得到了政府资助的韩国国家研究基金会（MIST）资助的研究基金的支持。

2023R1A2C1006309).Author informationAuthor notesJung Soo Park and Changshin Kang contributed equally to this work.Authors and AffiliationsDepartment of Emergency Medicine, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, Republic of KoreaJung Soo Park, Changshin Kang, Jin Hong Min, Yeonho You, Wonjoon Jeong, Hong Joon Ahn, Yong Nam In & Se Kwang OhDepartment of Emergency Medicine, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of KoreaJung Soo Park, Changshin Kang, Yeonho You, Wonjoon Jeong, Hong Joon Ahn & So Young JeonDepartment of Emergency Medicine, Chungnam National University Sejong Hospital, 7, Bodam-ro, Sejong, Republic of KoreaJin Hong Min, Yong Nam In & Se Kwang OhDepartment of Emergency Medicine, Chungbuk National University Hospital, 1473, Seobu-ro, Seowon-gu, Cheongju-si, Chungcheongbuk-do, Republic of KoreaYoung Min KimDepartment of Radiology, College of Medicine, Chungnam National University, 266, Munhwa-ro, Jung-gu, Daejeon, Republic of KoreaIn Ho LeeDepartment of Neurology, Chungnam National University Hospital, 282, Munhwa-ro, Jung-gu, Daejeon, Republic of KoreaHye Seon JeongDepartment of Emergency Medicine, Chonnam National University Medical School, Chonnam National University Hospital, 160, Baekseo-ro, Dong-gu, Gwangju, Republic of KoreaByung Kook LeeAuthorsJung Soo ParkView a.

2023R1A2C1006309）。作者信息作者注：朴正洙和康常欣对这项工作做出了同样的贡献。作者和所属机构忠南国立大学医学院急诊医学系，266，韩国共和国大田市正谷市蒙和路，韩国共和国正洙公园，常欣康，金红民，Yeonho You，Wonjoon Jeong，Hong Joon Ahn，Yong Nam In＆Se Kwang Oh忠南国立大学医院急诊医学系，282，韩国共和国大田市正洙公园，常欣康，Yeonho You，Wonjoon Jeong，忠南国立大学世宗医院急诊科Hong Joon Ahn&So Young JeonDepartment of Emergency Medicine，忠南国立大学附属医院急诊科，1473，Seowon gu Seobu ro，Cheongju si，Chungcheongbuk do，Republic of Korea Young Kim忠南国立大学医学院放射科，266，Munhwa ro，Jung gu，Daejeon，韩国共和国忠南国立大学医院神经病学系，282，Munhwa ro，Jung gu，Daejeon，KoreaHye Seon Jeong韩国共和国忠南国立大学医学院急诊医学系，忠南国立大学医院，160，Baekseo ro，Dong gu，Gwangju，Koreabyong Kook Lee共和国作家Jung Soo ParkView a。

PubMed Google ScholarChangshin KangView author publicationsYou can also search for this author in

PubMed Google ScholarChangshin KangView作者出版物您也可以在

PubMed Google ScholarJin Hong MinView author publicationsYou can also search for this author in

PubMed谷歌学者Jin Hong MinView作者出版物您也可以在

PubMed Google ScholarYeonho YouView author publicationsYou can also search for this author in

PubMed Google ScholarYeonho YouView作者出版物您也可以在

PubMed Google ScholarWonjoon JeongView author publicationsYou can also search for this author in

PubMed Google ScholarWonjoon JeongView作者出版物您也可以在

PubMed Google ScholarHong Joon AhnView author publicationsYou can also search for this author in

PubMed Google ScholarHong Joon AhnView作者出版物您也可以在

PubMed Google ScholarYong Nam InView author publicationsYou can also search for this author in

PubMed Google ScholarYoung Min KimView author publicationsYou can also search for this author in

PubMed Google ScholarYoung Min KimView作者出版物您也可以在

PubMed Google ScholarSe Kwang OhView author publicationsYou can also search for this author in

PubMed Google ScholarSe Kwang OhView作者出版物您也可以在

PubMed Google ScholarSo Young JeonView author publicationsYou can also search for this author in

PubMed Google ScholarSo Young JeonView作者出版物您也可以在

PubMed Google ScholarIn Ho LeeView author publicationsYou can also search for this author in

PubMed Google ScholarIn Ho LeeView作者出版物您也可以在

PubMed Google ScholarHye Seon JeongView author publicationsYou can also search for this author in

PubMed Google ScholarHye Seon JeongView作者出版物您也可以在

PubMed Google ScholarByung Kook LeeView author publicationsYou can also search for this author in

PubMed Google ScholarByung Kook LeeView作者出版物您也可以在

PubMed Google ScholarContributionsJSP, CSK, and JHM contributed to the study of conception, design analyzed the data, and wrote the paper. YHY, WJJ, HJA, and YNI contributed to data acquisition. YMK and SKO contributed to data analysis and interpretation. SYJ, IHL, HSJ, and BKL contributed to the statistical analysis.

PubMed Google ScholarContributionsJSP，CSK和JHM为概念研究做出了贡献，设计分析了数据，并撰写了论文。YHY，WJJ，HJA和YNI为数据采集做出了贡献。。SYJ，IHL，HSJ和BKL为统计分析做出了贡献。

All authors made relevant intellectual contributions to the manuscript, and all authors approved the final version for journal submission. All authors read and approved the final manuscript.Corresponding authorCorrespondence to.

所有作者都对稿件做出了相关的智力贡献，所有作者都批准了期刊提交的最终版本。所有作者都阅读并批准了最终稿件。对应作者对应。

Jin Hong Min.Ethics declarations

金洪敏。道德宣言

Ethics approval and consent to participate

道德批准和同意参与

The study was conducted according to the guidelines of the Declaration of Helsinki and was approved by the institutional review boards of each hospital (CNUSH 2023-03-019-001; approval date: April 27, 2023, CNUH 2023-04-003; approval date: April 28, 2023, CBNUH 2023-03-038; approval date: April 19, 2023).

这项研究是根据赫尔辛基宣言的指导方针进行的，并得到了每家医院的机构审查委员会的批准（CNUSH 2023-03-019-001；批准日期：2023年4月27日，CNUH 2023-04-003；批准日期：2023年4月28日，CBNUH 2023-03-038；批准日期：2023年4月19日）。

The extracted data included clinical data only, and no personally identifiable information. Therefore, the need for obtaining informed consent from the patients was waived..

提取的数据仅包括临床数据，没有个人识别信息。因此，放弃了获得患者知情同意的必要性。。

Competing interests

相互竞争的利益

The authors declare no competing interests.

作者声明没有利益冲突。

Additional informationPublisher’s noteSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.Electronic supplementary materialBelow is the link to the electronic supplementary material.Supplementary Material 1Supplementary Material 4Rights and permissions.

Additional informationPublisher的noteSpringer Nature在已发布地图和机构隶属关系中的管辖权主张方面保持中立。电子补充材料流是指向电子补充材料的链接。补充材料1补充材料4权利和许可。

Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material.

开放获取本文是根据知识共享署名非商业性NoDerivatives 4.0国际许可证授权的，该许可证允许以任何媒介或格式进行任何非商业性使用，共享，分发和复制，只要您对原始作者和来源给予适当的信任，提供知识共享许可证的链接，并指出您是否修改了许可材料。

You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/..

要查看此许可证的副本，请访问http://creativecommons.org/licenses/by-nc-nd/4.0/..

Reprints and permissionsAbout this articleCite this articlePark, J.S., Kang, C., Min, J.H. et al. Optimal timing of ultra-early diffusion-weighted MRI in out-of-hospital cardiac arrest patients based on a retrospective multicenter cohort study.

转载和许可本文引用本文Park，J.S.，Kang，C.，Min，J.H。等人。基于回顾性多中心队列研究，院外心脏骤停患者超早期扩散加权MRI的最佳时机。

Sci Rep 14, 25284 (2024). https://doi.org/10.1038/s41598-024-76418-6Download citationReceived: 17 March 2024Accepted: 14 October 2024Published: 25 October 2024DOI: https://doi.org/10.1038/s41598-024-76418-6Share this articleAnyone you share the following link with will be able to read this content:Get shareable linkSorry, a shareable link is not currently available for this article.Copy to clipboard.

Sci Rep 1425284（2024）。https://doi.org/10.1038/s41598-024-76418-6Download引文接收日期：2024年3月17日接受日期：2024年10月14日发布日期：2024年10月25日OI：https://doi.org/10.1038/s41598-024-76418-6Share本文与您共享以下链接的任何人都可以阅读此内容：获取可共享链接对不起，本文目前没有可共享的链接。复制到剪贴板。

Provided by the Springer Nature SharedIt content-sharing initiative

由Springer Nature SharedIt内容共享计划提供

KeywordsCardiopulmonary resuscitationDiffusion magnetic resonance imagingOut-of-hospital cardiac arrestReturn of spontaneous circulationPost-cardiac arrest syndrome

关键词心血管肺复苏扩散磁共振成像医院心脏骤停自主循环恢复心脏骤停后综合征

全球产业链接平台

重庆市渝北区金星科技大厦A区5楼512室

联系电话：023-67139735（重庆）

关于我们

产品服务