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Nishiyama K, Ito N, Orita T, Hayashida K, Arimoto H, Beppu S, Abe M, Unoki T, Endo T, Murai A, Hatada T, Yamada N, Mizobuchi M, Himeno H, Okuchi K, Yasuda H, Mochizuki T, Shiga K, Kikuchi M, Tsujimura Y, Hatanaka T, Nagao K. Regional cerebral oxygen saturation monitoring for predicting interventional outcomes in patients following out-of-hospital cardiac arrest of presumed cardiac cause: A prospective, observational, multicentre study. Resuscitation 2015; 96:135-41. [DOI: 10.1016/j.resuscitation.2015.07.049] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/08/2015] [Accepted: 07/29/2015] [Indexed: 10/23/2022]
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Nishiyama K, Ito N, Orita T, Hayashida K, Arimoto H, Abe M, Unoki T, Endo T, Murai A, Ishikura K, Yamada N, Mizobuchi M, Anan H, Watanabe T, Yasuda H, Homma Y, Shiga K, Tokura M, Tsujimura Y, Hatanaka T, Nagao K. Characteristics of regional cerebral oxygen saturation levels in patients with out-of-hospital cardiac arrest with or without return of spontaneous circulation: A prospective observational multicentre study. Resuscitation 2015. [PMID: 26215479 DOI: 10.1016/j.resuscitation.2015.07.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Our study aimed at filling the fundamental knowledge gap on the characteristics of regional brain oxygen saturation (rSO2) levels in out-of-hospital cardiac arrest (OHCA) patients with or without return of spontaneous circulation (ROSC) upon arrival at the hospital for estimating the quality of cardiopulmonary resuscitation and neurological prognostication in these patients. METHODS We enrolled 1921 OHCA patients from the Japan - Prediction of Neurological Outcomes in Patients Post-cardiac Arrest Registry and measured their rSO2 immediately upon arrival at the hospital by near-infrared spectroscopy using two independent forehead probes (right and left). We also assessed the percentage of patients with a good neurological outcome (defined as cerebral performance categories 1 or 2) 90 days post cardiac arrest. RESULTS After 90 days, 79 (4%) patients had good neurological outcomes and a median lower rSO2 level of 15% (15-20%). Compared to patients without ROSC upon arrival at the hospital, those with ROSC had significantly higher rSO2 levels (56% [39-65%] vs. 15% [15-17%], respectively; P<0.01), and significantly correlated right- and left-sided regional brain oxygen saturation levels (R=0.94 vs. 0.66, respectively). In both groups, the percentage of patients with a good 90-day neurological outcome increased significantly in proportion to their rSO2 levels upon arrival at the hospital (P<0.01). CONCLUSION Our data indicate that measuring rSO2 levels might be effective for both monitoring the quality of resuscitation and neurological prognostication in patients with OHCA.
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Affiliation(s)
- Kei Nishiyama
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - Noritoshi Ito
- Department of Cardiovascular Medicine, Kawasaki Saiwai Hospital, Kawasaki, Japan
| | - Tomohiko Orita
- Department of Emergency and Critical Care Medicine, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan
| | - Kei Hayashida
- Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Arimoto
- Department of Emergency and Critical Care Medical Center, Osaka City General Hospital, Osaka, Japan
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Unoki
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Tomoyuki Endo
- Advanced Emergency Center, Tohoku University Hospital, Sendai, Japan
| | - Akira Murai
- Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
| | - Ken Ishikura
- Critical Care Center, Mie University Hospital, Tsu, Japan
| | - Noriaki Yamada
- Advanced Critical Care Center, Gifu University Hospital, Gifu, Japan
| | | | - Hideaki Anan
- Department of Cardiology, Fujisawa City Hospital, Fujisawa, Japan
| | - Tomorou Watanabe
- Advanced Critical Care Center, Nara Medical University Hospital, Kashihara, Japan
| | - Hideto Yasuda
- Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Musashino, Japan
| | - Yosuke Homma
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Kazuhiro Shiga
- Emergency and Critical Care Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan
| | - Michiaki Tokura
- Department of Cardiovascular Medicine, Dokkyo Medical University, Tochigi, Japan
| | - Yuka Tsujimura
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto, Japan
| | | | - Ken Nagao
- Department of Cardiology, Surugadai Nihon University Hospital, Tokyo, Japan
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Wally D, Velik-Salchner C. [Near-infrared spectroscopy during cardiopulmonary resuscitation and mechanical circulatory support: From the operating room to the intensive care unit]. Med Klin Intensivmed Notfmed 2015; 110:621-30. [PMID: 25917180 DOI: 10.1007/s00063-015-0012-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Revised: 01/07/2015] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Near infrared spectroscopy (NIRS) allows continuous measurement of cerebral regional oxygen saturation (rSO2). It is a weighted saturation value derived from approximately 70-75 % venous, 20-25 % arterial and 2.5-5 % capillary blood. In contrast to pulse oximetry, NIRS is independent of pulsatile flow. Therefore, it is also applicable during extracorporeal circulation, cardiopulmonary resuscitation (CPR), and hypothermia. OBJECTIVES The purpose of this work is to describe the application of cerebral and somatic NIRS in cardiology and cardiac surgery patients in the operation room, during and after CPR, and during the intensive care unit stay. MATERIALS AND METHODS This article is based on peer-reviewed literature from PubMed. RESULTS Interventions based on decline of cerebral NIRS values during on-pump cardiac surgery can reduce major organ morbidity and mortality; however, the appearance of a postoperative cognitive dysfunction is scarcely influenced. Persisting of low cerebral oximetry values during resuscitation is a marker for not achieving return of spontaneous circulation under normothermia. NIRS is an additional method for monitoring that can be used during extracorporeal circulation. CONCLUSION NIRS is a rapidly available, user-friendly, and noninvasive method for continuous measurement of rSO2. NIRS provides additional information about tissue oxygenation especially during resuscitation and extracorporeal circulatory assist support. Recommendations concerning the use of NIRS for standard monitoring during resuscitation and mechanical circulatory support are not currently available. Further studies are required to show if use of NIRS can reduce pulse control and hands-off times during resuscitation and if use of NIRS can improve outcome after CPR and mechanical circulatory support.
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Affiliation(s)
- D Wally
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - Corinna Velik-Salchner
- Universitätsklinik für Anästhesie und Intensivmedizin, Department für Operative Medizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Cerebral oximetry and cerebral blood flow monitoring in 2 pediatric survivors with out-of-hospital cardiac arrest. Am J Emerg Med 2013; 32:394.e5-394.e10. [PMID: 24275043 DOI: 10.1016/j.ajem.2013.10.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 10/21/2013] [Indexed: 11/22/2022] Open
Abstract
In pediatric out-of-hospital cardiac arrest (POHCA), cardiovascular monitoring tools have improved resuscitative endeavors and cardiovascular outcomes but with still poor neurologic outcomes. Regarding cardiac arrest in patients with congenital heart disease during surgery, the application of cerebral oximetry with blood volume index (BVI) during the resuscitation has shown significant results and prognostic significance. We present 2 POHCA patients who had cerebral oximetry with BVI monitoring during their arrest and postarrest phase in the emergency department and its potential prognostic aspect.Basic procedures include left and right cerebral oximetry with BVI monitoring at every 5-second interval during cardiac arrest, resuscitation, and postarrest in 2 POHCA patients in the pediatric emergency department.Regional cerebral tissue oxygen saturation (rSo2) with BVI readings in these 2 POHCA survivors demonstrated interesting cerebral physiology, blood flow, and potential prognostic outcome. In 1 patient, the reference range of cerebral rSo2 with positive blood flow during arrest and postarrest phases consistently occurred. This neurologic monitoring had its significance when the resuscitation effectiveness was used and end-tidal CO2 changes were lost. The other patient's cerebral rSo2 with simultaneous BVI readings and trending showed the effectiveness of the emergency medical services (EMS) resuscitation.Cerebral oximetry with cerebral blood flow index monitoring in these POHCA survivors demonstrates compelling periarrest and postarrest cerebral physiology information and prognostication. Cerebral oximetry with cerebral BVI monitoring during these arrest phases has potential as a neurologic monitor for the resuscitative intervention's effectiveness and its possible neurologic prognostic application in the pediatric OCHA patients.
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Skhirtladze-Dworschak K, Dworschak M. Cerebral oximetry and cardiac arrest. Semin Cardiothorac Vasc Anesth 2013; 17:269-75. [PMID: 23782549 DOI: 10.1177/1089253213492861] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cerebral oximetry is a Food and Drug Administration-approved technology that allows monitoring of brain oxygen saturation in accessible superficial brain cortex regions, which are amongst the most vulnerable in regard to ischemic or hypoxic injury. Since most oxygen in the area of interest is located in the venous compartment, the determined regional brain oxygen saturation approximately reflects the local balance between oxygen delivery and oxygen consumption. Major systemic alterations in blood oxygen content and oxygen delivery will be accompanied by corresponding changes in regional brain saturation. This systematic review, which is based on a Medline search, focuses on the characteristic changes in regional cerebral oxygen saturation that occur, when global oxygen supply to the brain ceases. It further highlights the potential application of cerebral oximetry in the management of cardiac arrest victims, the predictability of clinical outcome after global cerebral ischemia, and it also indicates possible potentials for the management of cerebral reperfusion after having instituted return of spontaneous circulation.
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