Cerebrospinal fluid features in comatose survivors of cardiac arrest: A pilot study

• Published in: PloS one 2022-07, Vol.17 (7), p.e0270954-e0270954
• Main Authors: Paul, Marine, Benghanem, Sarah, Merceron, Sybille, Bellut, Hugo, Dumas, Florence, Henry, Amandine, Bruneel, Fabrice, Bedos, Jean-Pierre, Cariou, Alain, Legriel, Stéphane
• Format: Article
• Language: English
• Subjects: Abnormalities; Biology and Life Sciences; Blood-brain barrier; Cardiac arrest; Cardiology and cardiovascular system; Causes of; Cerebrospinal fluid; Coma; Composition; Data collection; Diagnosis; Emergency medical care; Etiology; Health aspects; Health risks; Heart; Human health and pathology; Intensive care; Life Sciences; Medical diagnosis; Medical imaging; Medicine and Health Sciences; Metabolism; Multivariate analysis; Neurobiology; Neurons and Cognition; Patient outcomes; Patients; Proteins; Puncture; Research and Analysis Methods; Risk analysis; Risk factors; Santé publique et épidémiologie; Spine; Tomography
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0270954

Lumbar puncture is among the investigations used to identify various neurological conditions, including some that can cause cardiac arrest (CA). However, CA per se may alter cerebrospinal fluid (CSF) characteristics. Few studies have investigated CSF findings after CA. In this descriptive work, we assessed the frequency and risk factors of abnormal CSF findings after CA and the contribution of CSF analysis to the etiological diagnosis. We retrospectively studied data from prospectively established databases of consecutive patients who were admitted to two French ICUs in 2007-2016 with sustained return of spontaneous circulation (ROSC) after CA and who underwent lumbar puncture as an etiological investigation. Of 1984 patients with sustained ROSC, 55 (2.7%) underwent lumbar puncture and were included. Lumbar puncture identified a neurological cause of CA in 2/55 (3.6%) patients. Nonspecific CSF abnormalities were noted in 37/53 (69.8%) patients. By multivariate analysis, postresuscitation shock was positively associated with CSF abnormalities (OR, 6.92; 95% confidence interval [95%CI], 1.62-37.26; P = 0.013). A no-flow time above 6 minutes (OR, 0.19; 95%CI, 0.03-1.11; P = 0.076) and a respiratory cause of CA (OR, 2.91; 95%CI, 0.53-23.15; P = 0.24) were not statistically associated with CSF abnormalities. Nonspecific CSF abnormalities were not significantly associated with poor outcomes (Cerebral Performance Category [greater than or equal to]3; P = 0.06). Lumbar puncture, although infrequently performed, may contribute to the etiological diagnosis of CA, albeit rarely. Nonspecific CSF abnormalities seem common after CA, notably with postresuscitation shock, and may be related to blood-brain barrier disruption. These findings may help to interpret CSF findings after CA. Further studies are warranted to assess our results.