naa a22 4500 510800300 CHVBK 20180411083352.0 cr unu---uuuuu 180411e20130401xx s 000 0 eng 10.1007/s12028-012-9683-3 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9683-3 Factors Associated with Favorable Response to Hyperbaric Oxygen Therapy among Patients Presenting with Iatrogenic Cerebral Arterial Gas Embolism [Elektronische Daten] [Wondwossen Tekle, Cheryl Adkinson, Saqib Chaudhry, Vikram Jadhav, Ameer Hassan, Gustavo Rodriguez, Adnan Qureshi] 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 24h 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, 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 ≤6h (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 24h 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 outcomes. Time-to-HBO2 ≤6h increased the odds of favorable outcome, whereas the presence of infarct/edema on CT/MRI scan before HBO2 reduced the odds of a favorable outcome. Timely diagnosis and differentiation from thrombo-embolic ischemic events appears to be an important determinant of successful HBO2 treatment. Springer Science+Business Media, LLC, 2012 Iatrogenic cerebral gas embolism nationallicence Air embolism nationallicence Hyperbaric oxygen nationallicence Stroke nationallicence Tekle Wondwossen Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Adkinson Cheryl Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA aut Chaudhry Saqib Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Jadhav Vikram Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Hassan Ameer Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Rodriguez Gustavo Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Qureshi Adnan Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut Neurocritical Care Humana Press Inc 18/2(2013-04-01), 228-233 1541-6933 18:2<228 2013 18 12028 https://doi.org/10.1007/s12028-012-9683-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9683-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Tekle Wondwossen Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Adkinson Cheryl Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Chaudhry Saqib Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Jadhav Vikram Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Hassan Ameer Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Rodriguez Gustavo Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 700 1- Qureshi Adnan Zeenat Qureshi Stroke Research Center, Department of Neurology, University of Minnesota, 12-100 PWB, 516 Delaware St. SE, 55455, Minneapolis, MN, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/2(2013-04-01), 228-233 1541-6933 18:2<228 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer