Predictive Utility of Changes in Optic Nerve Sheath Diameter after Cardiac Arrest for Neurologic Outcomes

Abstract

The optic nerve sheath diameter (ONSD) can help predict the neurologic outcomes of patients with post-cardiac arrest (CA) return of spontaneous circulation (ROSC). We aimed to investigate the effect of ONSD changes before and after CA on neurologic outcomes in patients with ROSC after CA using brain computed tomography (CT). The study included patients hospitalized after CA, who had undergone pre- and post-CA brain CT between January 2001 and September 2020. The patients were divided into good and poor neurologic outcome (GNO and PNO, respectively) groups based on their neurologic outcome at hospital discharge. We performed between-group comparisons of the amount and rate of ONSD changes in brain CT and calculated the area under the curve (AUC) to determine their predictive value for neurologic outcomes. Among the 96 enrolled patients, 25 had GNO. Compared with the GNO group, the PNO group showed a significantly higher amount (0.30 vs. 0.63 mm; p = 0.030) and rate (5.26 vs. 12.29%; p = 0.041) of change. The AUC for predicting PNO was 0.64 (95% confidence interval = 0.53–0.73; p = 0.04), and patients with a rate of ONSD change >27.2% had PNO with 100% specificity and positive predictive value. Hence, ONSD changes may predict neurologic outcomes in patients with post-CA ROSC.

Additional predictive value of optic nerve sheath diameter for neurological prognosis after cardiac arrest: a prospective cohort study

“…We found a large variance in ONSD measurements, which might be partly caused by human variability. This problem could be overcome by looking at changes of ONSD relative to pre-cardiac arrest ONSD [ 27 ]. Nonetheless, pre-cardiac arrest ONSD is usually not available.…”

Optic Nerve Sheath Diameter for Predicting Outcomes in Post-Cardiac Arrest Syndrome: An Updated Systematic Review and Meta-Analysis

“…This difference in the TTM rate may have affected the neurological outcomes of patients. Third, in healthy adults, there are differences in the baseline ONSD according to individual characteristics including sex, body mass index (BMI), race, or eyeball size [ 34 , 35 , 36 ]. Most studies conducted on healthy volunteers have demonstrated varying mean or median ONSD values across study cohorts, depending on race or measurement tools [ 37 , 38 ].…”

Can Optic Nerve Sheath Images on a Thin-Slice Brain Computed Tomography Reconstruction Predict the Neurological Outcomes in Cardiac Arrest Survivors?

“…Inflammatory processes of the optic nerve sheath (as in optic neuritis, multiple sclerosis and vasculitis) can cause perineural edema that increases the ONSD [30,31]. Additionally, since the ONSD can vary from person to person, the ONSD may not fully reflect the IICP [32]. Thus, using the ONSD measurement in isolation to predict a poor outcome is unwarranted, and it should only be used as one test within a multimodal prognostic approach.…”