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Cardiac arrest related lung edema: examining the role of downtimes in transpulmonary thermodilution analysis

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Abstract

Pulmonary edema and its association with low flow times has been observed in postcardiac arrest patients. However, diagnosis of distinct types of lung pathology is difficult.The aim of this study was to investigate pulmonary edema by transpulmonary thermodilution (TPTD) after out-of-hospital cardiac arrest (OHCA), and the correlation to downtimes. In this retrospective single-center study consecutive patients with return of spontaneous circulation (ROSC) following OHCA, age ≥ 18, and applied TPTD were enrolled. According to downtimes, patients were divided into a short and a long no-flow-time group, and data of TPTD were analysed. We identified 45 patients (n = 25 short no-flow time; n = 20 long no-flow time) who met the inclusion criteria. 24 h after ROSC, the extra vascular lung water index (EVLWI) was found to be lower in the group with short no-flow time compared to the group with long no-flow time (10.7 ± 3.5 ml/kg vs. 12.8 ± 3.9 ml/kg; p = 0.08) and remained at a similar level 48 h (10.9 ± 4.3 ml/kg vs. 12.9 ± 4.9 ml/kg; p = 0.25) and 72 h (11.1 ± 5.0 ml/kg vs. 13.9 ± 7.7 ml/kg; p = 0.27) post-ROSC. We found a statistically significant and moderate correlation between no-flow duration and EVLWI 48 h (r = 0.51; p = 0.002) and 72 h (r = 0.54; p = 0.004) post-ROSC. Pulmonary vascular permeability index (PVPI) was not correlated with downtimes. Our observation underlines the presence of cardiac arrest-related lung edema by determination of EVLWI. The duration of no-flow times is a relevant factor for increased extravascular lung water index.

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Authors and Affiliations

  1. Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany

    Ingo Voigt & Marco Mighali

  2. Department of Cardiology and Angiology, Contilia Heart and Vascular Center Elisabeth-Hospital Essen, Essen, Germany

    Heinrich Wieneke & Oliver Bruder

  3. Faculty of Medicine, University Duisburg-Essen, Essen, Germany

    Heinrich Wieneke

  4. Faculty of Medicine, Ruhr University Bochum, Bochum, Germany

    Oliver Bruder

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IV conceptualization, methodology, investigation, writing—original draft, writing—review and editing, visualization. MM investigation, writing—review and editing. HW, OB writing—review and editing, supervision.

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Correspondence to Ingo Voigt.

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Ethical Statement

Ethical approval was waived by the Ethics Committee of the regional Medical Association (North-Rhine; Nr. 20210506) because of the retrospective nature of the study, and all the procedures performed were part of routine care. Procedures were followed in accordance with the ethical and data protection standards of the approving committees and with the Helsinki Declaration of 1975.

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11739_2023_3420_MOESM1_ESM.pdf

Supplementary file1 Online Resource 1 Inflammatory biomarkers post- ROSC : At admission (Leuko0,CRP0), 24h (Leuko24,CRP24), 48h (Leuko48,CRP48) and 72h(Leuko72,CRP72) post-ROSC (PDF 93 KB)

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Voigt, I., Mighali, M., Wieneke, H. et al. Cardiac arrest related lung edema: examining the role of downtimes in transpulmonary thermodilution analysis. Intern Emerg Med 19, 501–509 (2024). https://doi.org/10.1007/s11739-023-03420-7

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