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Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.

ABSTRACT: By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO?) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO? values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC.We performed an observational study to measure rSO? using Equanox (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting.rSO? of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO? value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) (P?=?0.02). Mean rSO? from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39%?±?7 and 31%?±?4 (P?=?0.05) respectively.During pre-hospital advanced life support, higher increases in rSO? are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO? could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.

SUBMITTER: Genbrugge C

PROVIDER: S-EPMC4377035 | biostudies-literature | 2015 Mar

REPOSITORIES: biostudies-literature

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Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.

Genbrugge Cornelia C Meex Ingrid I Boer Willem W Jans Frank F Heylen René R Ferdinande Bert B Dens Jo J De Deyne Cathy C

Critical care (London, England) 20150324

<h4>Introduction</h4>By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO₂) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO₂ values during advanced life support from patients with return ...[more]

PMID: 25887259

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Project description:This study aimed to identify neurological and pathophysiological factors that predicted return of spontaneous circulation (ROSC) among patients with out-of-hospital cardiac arrest (OHCA). This prospective 1-year observational study evaluated patients with cardiogenic OHCA who were admitted to a tertiary medical center, Nippon Medical School Hospital. Physiological and neurological examinations were performed at admission for quantitative infrared pupillometry (measured with NPi-200, NeurOptics, CA, USA), arterial blood gas, and blood chemistry. Simultaneous blood samples were also collected to determine levels of neuron-specific enolase (NSE), S-100b, phosphorylated neurofilament heavy subunit, and interleukin-6. In-hospital standard advanced cardiac life support was performed for 30?minutes.The ROSC (n?=?26) and non-ROSC (n?=?26) groups were compared, which a revealed significantly higher pupillary light reflex ratio, which was defined as the percent change between maximum pupil diameter before light stimuli and minimum pupil diameter after light stimuli, in the ROSC group (median: 1.3% [interquartile range (IQR): 0.0-2.0%] vs. non-ROSC: (median: 0%), (Cut-off: 0.63%). Furthermore, NSE provided the great sensitivity and specificity for predicting ROSC, with an area under the receiver operating characteristic curve of 0.86, which was created by plotting sensitivity and 1-specificity. Multivariable logistic regression analyses revealed that the independent predictors of ROSC were maximum pupillary diameter (odds ratio: 0.25, 95% confidence interval: 0.07-0.94, P?=?0.04) and NSE at admission (odds ratio: 0.96, 95% confidence interval: 0.93-0.99, P?=?0.04). Pupillary diameter was also significantly correlated with NSE concentrations (r?=?0.31, P?=?0.027). Conclusively, the strongest predictors of ROSC among patients with OHCA were accurate pupillary diameter and a neuronal biomarker, NSE. Quantitative pupillometry may help guide the decision to terminate resuscitation in emergency departments using a neuropathological rationale. Further large-scale studies are needed.

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Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.

Publications

Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation.

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