Association of Arterial Carbon Dioxide Tension Following In-Hospital Cardiac Arrest With Survival and Favorable Neurologic Outcome.

BACKGROUND: In-hospital cardiac arrest (IHCA) continues to be associated with high morbidity and mortality. The objective of this study was to study the association of arterial carbon dioxide tension (PaCO2) on survival to discharge and favorable neurologic outcomes in adults with IHCA. METHODS: The study population included 353 adults who underwent resuscitation from 2011 to 2019 for IHCA at an academic tertiary care medical center with arterial blood gas testing done within 24 hours of arrest. Outcomes of interest included survival to discharge and favorable neurologic outcome, defined as Glasgow outcome score of 4-5. RESULTS: Of the 353 patients studied, PaCO2 classification included: hypocapnia (PaCO2 <35 mm Hg, n = 89), normocapnia (PaCO2 35-45 mm Hg, n = 151), and hypercapnia (PaCO2 >45 mm Hg, n = 113). Hypercapnic patients were further divided into mild (45 mm Hg < PaCO2 ≤55 mm Hg, n = 62) and moderate/severe hypercapnia (PaCO2 > 55 mm Hg, n = 51). Patients with normocapnia had the highest rates of survival to hospital discharge (52.3% vs. 32.6% vs. 30.1%, P < 0.001) and favorable neurologic outcome (35.8% vs. 25.8% vs. 17.9%, P = 0.005) compared those with hypocapnia and hypercapnia respectively. In multivariable analysis, compared to normocapnia, hypocapnia [odds ratio (OR), 2.06; 95% confidence interval (CI), 1.15-3.70] and hypercapnia (OR, 2.67; 95% CI, 1.53-4.66) were both found to be independently associated with higher rates of in-hospital mortality. Compared to normocapnia, while mild hypercapnia (OR, 2.53; 95% CI, 1.29-4.97) and moderate/severe hypercapnia (OR, 2.86; 95% CI, 1.35-6.06) were both independently associated with higher in-hospital mortality compared to normocapnia, moderate/severe hypercapnia was also independently associated with lower rates of favorable neurologic outcome (OR, 0.28; 95% CI, 0.11-0.73), while mild hypercapnia was not. CONCLUSIONS: In this prospective registry of adults with IHCA, hypercapnia noted within 24 hours after arrest was independently associated with lower rates of survival to discharge and favorable neurologic outcome.

Deadly Neuroinvasive Mosquito-Borne Virus: A Case of Eastern Equine Encephalitis.

None: Eastern equine encephalitis (EEE) is a rare and potentially fatal neuroinvasive disease with a high mortality rate of > 30%. It is an uncommon vector-borne illness, with an average of 8 cases reported in the United States annually. Alarmingly, in 2019 alone, the Centers for Disease Control and Prevention (CDC) confirmed 38 cases of EEE virus in the United States, reported from 10 states. In this report, we describe a 42-year-old man who worked primarily in wooded areas and presented to a hospital in southern New Jersey with an intractable headache and global facial paraesthesia. He reported multiple tick bites in the weeks prior to his presentation. Based on high clinical suspicion, cerebrospinal samples were sent to the CDC, which confirmed the diagnosis of EEE. The patient was treated with supportive care, and, after spending 9 days on mechanical ventilation in the intensive care unit, he was extubated and subsequently had some improvement of his symptoms with the implementation of an extensive physical therapy program. We hope this report will contribute to increasing awareness among the public health and medical communities regarding the increasing number of EEE cases and the importance of following prevention measures, especially in areas with high prevalence and early recognition of the disease for treatment.