Near-infrared spectroscopy after out-of-hospital cardiac arrest

Critical Care

Matti Reinikainen¹  Sirkku Heino²  Pekka Jakkula³  Hiski Kopponen³  Erika Wilkman³  Ville Pettilä³  Minna Bäcklund³  Johanna Hästbacka³  Markus B. Skrifvars⁴  Marjaana Tiainen⁵  Anni Pulkkinen⁶  Thomas Birkelund⁷  Stepani Bendel⁸  Pekka Loisa⁹  Sari Karlsson^1,10 

[1] 0000 0001 0726 2490, grid.9668.1, Department of Anaesthesiology and Intensive Care, University of Eastern Finland and Kuopio University Hospital, Kuopio, Finland;0000 0004 0368 0478, grid.416446.5, Department of Anaesthesiology and Intensive Care, North Karelia Central Hospital, Joensuu, Finland;0000 0004 0410 2071, grid.7737.4, Department of Anaesthesiology, Intensive Care and Pain Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;0000 0004 0410 2071, grid.7737.4, Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;0000 0004 0410 2071, grid.7737.4, Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland;0000 0004 0449 0385, grid.460356.2, Department of Intensive Care, Central Finland Central Hospital, Jyväskylä, Finland;0000 0004 0512 597X, grid.154185.c, Aarhus University Hospital, Aarhus, Denmark;0000 0004 0628 207X, grid.410705.7, Department of Intensive Care, Kuopio University Hospital, Kuopio, Finland;0000 0004 0628 2838, grid.440346.1, Department of Intensive Care, Päijät-Häme Central Hospital, Lahti, Finland;0000 0004 0628 2985, grid.412330.7, Department of Intensive Care, Tampere University Hospital, Tampere, Finland;

关键词: Cardiac arrest;    Cerebral oxygenation;    Hypoxic ischemic encephalopathy;    Intensive care;    Neuron-specific enolase (NSE);   

DOI  :  10.1186/s13054-019-2428-3

来源: publisher

【 摘 要 】

BackgroundCerebral hypoperfusion may aggravate neurological damage after cardiac arrest. Near-infrared spectroscopy (NIRS) provides information on cerebral oxygenation but its relevance during post-resuscitation care is undefined. We investigated whether cerebral oxygen saturation (rSO2) measured with NIRS correlates with the serum concentration of neuron-specific enolase (NSE), a marker of neurological injury, and with clinical outcome in out-of-hospital cardiac arrest (OHCA) patients.MethodsWe performed a post hoc analysis of a randomised clinical trial (COMACARE, NCT02698917) comparing two different levels of carbon dioxide, oxygen and arterial pressure after resuscitation from OHCA with ventricular fibrillation as the initial rhythm. We measured rSO2 in 118 OHCA patients with NIRS during the first 36 h of intensive care. We determined the NSE concentrations from serum samples at 48 h after cardiac arrest and assessed neurological outcome with the Cerebral Performance Category (CPC) scale at 6 months. We evaluated the association between rSO2 and serum NSE concentrations and the association between rSO2 and good (CPC 1–2) and poor (CPC 3–5) neurological outcome.ResultsThe median (inter-quartile range (IQR)) NSE concentration at 48 h was 17.5 (13.4–25.0) μg/l in patients with good neurological outcome and 35.2 (22.6–95.8) μg/l in those with poor outcome, p < 0.001. We found no significant correlation between median rSO2 and NSE at 48 h, rs = − 0.08, p = 0.392. The median (IQR) rSO2 during the first 36 h of intensive care was 70.0% (63.5–77.0%) in patients with good outcome and 71.8% (63.3–74.0%) in patients with poor outcome, p = 0.943. There was no significant association between rSO2 over time and neurological outcome. In a binary logistic regression model, rSO2 was not a statistically significant predictor of good neurological outcome (odds ratio 0.99, 95% confidence interval 0.94–1.04, p = 0.635).ConclusionsWe found no association between cerebral oxygenation measured with NIRS and NSE concentrations or outcome in patients resuscitated from OHCA.Trial registrationClinicalTrials.gov, NCT02698917. Registered on 26 January 2016.

【 授权许可】

CC BY