Monitoring of cerebral oxygen saturation during resuscitation in out-of-hospital cardiac arrest: a feasibility study in a physician staffed emergency medical system

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Richard Ellerkmann¹  Ulrich Heister¹  Felix Erdfelder¹  Lars Eichhorn¹  Folkert Steinhagen¹  Jochen Kappler¹  Marcus O Thudium¹  Jens-Christian Schewe¹ 

[1] Department of Anaesthesiology, University of Bonn Medical Center, Sigmund-Freud-Str. 25, Bonn, 53105, Germany

关键词: Mechanical chest compression;    Resuscitation;    Near infrared spectroscopy;    Cerebral oximetry;    CPR;    NIRS;   

Others  :  1151920
DOI  :  10.1186/s13049-014-0058-y

 received in 2014-01-18, accepted in 2014-09-29,  发布年份 2014

【 摘 要 】

Background

Despite recent advances in resuscitation algorithms, neurological injury after cardiac arrest due to cerebral ischemia and reperfusion is one of the reasons for poor neurological outcome. There is currently no adequate means of measuring cerebral perfusion during cardiac arrest. It was the aim of this study to investigate the feasibility of measuring near infrared spectroscopy (NIRS) as a potential surrogate parameter for cerebral perfusion in patients with out-of-hospital resuscitations in a physician-staffed emergency medical service.

Methods

An emergency physician responding to out-of-hospital emergencies was equipped with a NONIN cerebral oximetry device. Cerebral oximetry values (rSO₂) were continuously recorded during resuscitation and transport. Feasibility was defined as >80% of total achieved recording time in relation to intended recording time.

Results

10 patients were prospectively enrolled. In 89.8% of total recording time, rSO₂ values could be recorded (213 minutes and 20 seconds), thus meeting feasibility criteria. 3 patients experienced return of spontaneous circulation (ROSC). rSO₂ during manual cardiopulmonary resuscitation (CPR) was lower in patients who did not experience ROSC compared to the 3 patients with ROSC (31.6%, ± 7.4 versus 37.2%?±?17.0). ROSC was associated with an increase in rSO₂. Decrease of rSO₂ indicated occurrence of re-arrest in 2 patients. In 2 patients a mechanical chest compression device was used. rSO₂ values during mechanical compression were increased by 12.7% and 19.1% compared to manual compression.

Conclusions

NIRS monitoring is feasible during resuscitation of patients with out-of-hospital cardiac arrest and can be a useful tool during resuscitation, leading to an earlier detection of ROSC and re-arrest. Higher initial rSO₂ values during CPR seem to be associated with the occurrence of ROSC. The use of mechanical chest compression devices might result in higher rSO₂. These findings need to be confirmed by larger studies.

【 授权许可】

   
2014 Schewe et al.; licensee BioMed Central Ltd.

【 图 表 】

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【 参考文献 】

• [1]Berdowski J, Berg RA, Tijssen JGP, Koster RW: Global incidences of out-of-hospital cardiac arrest and survival rates: Systematic review of 67 prospective studies. Resuscitation 2010, 81:1479-1487.
• [2]Fischer M, Fischer NJ, Schüttler J: One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ¿Utstein style¿. Resuscitation 1997, 33:233-243.
• [3]Herlitz J, Bahr J, Fischer M, Kuisma M, Lexow K, Thorgeirsson G: Resuscitation in Europe: a tale of five European regions. Resuscitation 1999, 41:121-131.
• [4]Neukamm J, Gräsner J-T, Schewe J-C, Breil M, Bahr J, Heister U, Wnent J, Bohn A, Heller G, Strickmann B, Fischer H, Kill C, Messelken M, Bein B, Lukas R, Meybohm P, Scholz J, Fischer M: The impact of response time reliability on CPR incidence and resuscitation success: a benchmark study from the German Resuscitation Registry. Crit Care Lond Engl 2011, 15:R282. BioMed Central Full Text
• [5]Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, Koster RW, Wyllie J, Böttiger B: European Resuscitation Council Guidelines for Resuscitation 2010 Section 1: Executive summary. Resuscitation 2010, 2010(81):1219-1276.
• [6]Arrich J, Holzer M, Havel C, Müllner M, Herkner H: Hypothermia for neuroprotection in adults after cardiopulmonary resuscitation. Cochrane Database Syst Rev 2012, 9:CD004128.
• [7]Chalkias A, Xanthos T: Post-cardiac arrest brain injury: pathophysiology and treatment. J Neurol Sci 2012, 315:1-8.
• [8]Pernat A, Weil MH, Sun S, Tang W: Stroke volumes and end-tidal carbon dioxide generated by precordial compression during ventricular fibrillation. Crit Care Med 2003, 31:1819-1823.
• [9]Bartlett RL, Stewart NJ Jr, Raymond J, Anstadt GL, Martin SD: Comparative study of three methods of resuscitation: closed-chest, open-chest manual, and direct mechanical ventricular assistance. Ann Emerg Med 1984, 13(9 Pt 2):773-777.
• [10]Fischer M, Dahmen A, Standop J, Hagendorff A, Hoeft A, Krep H: Effects of hypertonic saline on myocardial blood flow in a porcine model of prolonged cardiac arrest. Resuscitation 2002, 54:269-280.
• [11]Ghosh A, Elwell C, Smith M: Review article: cerebral near-infrared spectroscopy in adults: a work in progress. Anesth Analg 2012, 115:1373-1383.
• [12]Moerman A, Wouters P: Near-infrared spectroscopy (NIRS) monitoring in contemporary anesthesia and critical care. Acta Anaesthesiol Belg 2010, 61:185-194.
• [13]Ono M, Brady K, Easley RB, Brown C, Kraut M, Gottesman RF, Hogue CW Jr: Duration and magnitude of blood pressure below cerebral autoregulation threshold during cardiopulmonary bypass is associated with major morbidity and operative mortality. J Thorac Cardiovasc Surg 2014, 147:483-489.
• [14]Murkin JM, Adams SJ, Novick RJ, Quantz M, Bainbridge D, Iglesias I, Cleland A, Schaefer B, Irwin B, Fox S: Monitoring brain oxygen saturation during coronary bypass surgery: a randomized, prospective study. Anesth Analg 2007, 104:51-58.
• [15]Kämäräinen A, Sainio M, Olkkola KT, Huhtala H, Tenhunen J, Hoppu S: Quality controlled manual chest compressions and cerebral oxygenation during in-hospital cardiac arrest. Resuscitation 2012, 83:138-142.
• [16]Ito N, Nanto S, Nagao K, Hatanaka T, Nishiyama K, Kai T: Regional cerebral oxygen saturation on hospital arrival is a potential novel predictor of neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest. Resuscitation 2012, 83:46-50.
• [17]Koyama Y, Wada T, Lohman BD, Takamatsu Y, Matsumoto J, Fujitani S, Taira Y: A new method to detect cerebral blood flow waveform in synchrony with chest compression by near-infrared spectroscopy during CPR. Am J Emerg Med 2013, 31:1504-1508.
• [18]Newman DH, Callaway CW, Greenwald IB, Freed J: Cerebral oximetry in out-of-hospital cardiac arrest: standard CPR rarely provides detectable hemoglobin-oxygen saturation to the frontal cortex. Resuscitation 2004, 63:189-194.
• [19]Frisch A, Suffoletto BP, Frank R, Martin-Gill C, Menegazzi JJ: Potential utility of near-infrared spectroscopy in out-of-hospital cardiac arrest: an illustrative case series. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir 2012, 16:564-570.
• [20]Meex I, Deyne CD, Dens J, Scheyltjens S, Lathouwers K, Boer W, Vundelinckx G, Heylen R, Jans F: Feasibility of absolute cerebral tissue oxygen saturation during cardiopulmonary resuscitation. Crit Care 2013, 17:R36. BioMed Central Full Text
• [21]Ahn A, Nasir A, Malik H, D¿Orazi F, Parnia S: A pilot study examining the role of regional cerebral oxygen saturation monitoring as a marker of return of spontaneous circulation in shockable (VF/VT) and non-shockable (PEA/Asystole) causes of cardiac arrest. Resuscitation 2013, 84:1713-1716.
• [22]Duchateau F-X, Gueye P, Curac S, Tubach F, Broche C, Plaisance P, Payen D, Mantz J, Ricard-Hibon A: Effect of the AutoPulse automated band chest compression device on hemodynamics in out-of-hospital cardiac arrest resuscitation. Intensive Care Med 2010, 36:1256-1260.
• [23]Timerman S, Cardoso LF, Ramires JAF, Halperin H: Improved hemodynamic performance with a novel chest compression device during treatment of in-hospital cardiac arrest. Resuscitation 2004, 61:273-280.
• [24]Westfall M, Krantz S, Mullin C, Kaufman C: Mechanical versus manual chest compressions in Out-of-hospital cardiac arrest: a meta-analysis. Crit Care Med 2013, 41:1782-1798.
• [25]Ong MEH, Mackey KE, Zhang ZC, Tanaka H, Ma MH-M, Swor R, Shin SD: Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review. Scand J Trauma Resusc Emerg Med 2012, 20:39. BioMed Central Full Text
• [26]Kolb JC, Ainslie PN, Ide K, Poulin MJ: Effects of five consecutive nocturnal hypoxic exposures on the cerebrovascular responses to acute hypoxia and hypercapnia in humans. J Appl Physiol Bethesda Md 1985 2004, 96:1745-1754.
• [27]Morley PT: Monitoring the quality of cardiopulmonary resuscitation. Curr Opin Crit Care 2007, 13:261-267.