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

Schewe JC, Thudium MO, Kappler J, Steinhagen F, Eichhorn L, Erdfelder F, Heister U, Ellerkmann R - Scand J Trauma Resusc Emerg Med (2014)

Bottom Line: 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).The use of mechanical chest compression devices might result in higher rSO2.These findings need to be confirmed by larger studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University of Bonn Medical Center, Sigmund-Freud-Str, 25, Bonn, 53105, Germany. marcus.thudium@ukb.uni-bonn.de.

ABSTRACT

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.

Show MeSH

Related in: MedlinePlus

NIRS data of patient #8 with ROSC after initial asystole. After ROSC rSO2 increased slowly while circulation could only be maintained with high doses of vasopressors.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4196010&req=5

Fig3: NIRS data of patient #8 with ROSC after initial asystole. After ROSC rSO2 increased slowly while circulation could only be maintained with high doses of vasopressors.

Mentions: All 3 patients with ROSC were admitted to hospital. Of these patients, one (patient #1) was admitted to ICU after coronary intervention but eventually showed no signs of neurological recovery. CT scans showed extensive brain damage, so that therapy was limited and the patient died on ICU (see Figure 2 for NIRS data). The second patient (patient #5) to experience ROSC was discharged after successful coronary intervention and ICU stay without neurological impairment (Cerebral Performance Category, CPC 1, good performance). In the third patient where ROSC was achieved despite initial asystole (patient #8), rSO2 increased slowly after ROSC was detected (Figure 3). After ROSC, spontaneous circulation could only be maintained under massive doses of vasopressors during transport into the hospital and the patient died shortly after admission. 2 patients were transported to a hospital with ongoing CPR with manual as well as mechanical chest compressions (load distributing band CPR, AutoPulse® device, ZOLL, Chelmsford, MA, USA). In both cases, CPR attempts were terminated in the emergency department of the admitting hospital, based on further examination and laboratory results by the hospital physicians. In 5 cases (50%), resuscitation was unsuccessful and the patients died at the scene.Figure 2


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

Schewe JC, Thudium MO, Kappler J, Steinhagen F, Eichhorn L, Erdfelder F, Heister U, Ellerkmann R - Scand J Trauma Resusc Emerg Med (2014)

NIRS data of patient #8 with ROSC after initial asystole. After ROSC rSO2 increased slowly while circulation could only be maintained with high doses of vasopressors.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4196010&req=5

Fig3: NIRS data of patient #8 with ROSC after initial asystole. After ROSC rSO2 increased slowly while circulation could only be maintained with high doses of vasopressors.
Mentions: All 3 patients with ROSC were admitted to hospital. Of these patients, one (patient #1) was admitted to ICU after coronary intervention but eventually showed no signs of neurological recovery. CT scans showed extensive brain damage, so that therapy was limited and the patient died on ICU (see Figure 2 for NIRS data). The second patient (patient #5) to experience ROSC was discharged after successful coronary intervention and ICU stay without neurological impairment (Cerebral Performance Category, CPC 1, good performance). In the third patient where ROSC was achieved despite initial asystole (patient #8), rSO2 increased slowly after ROSC was detected (Figure 3). After ROSC, spontaneous circulation could only be maintained under massive doses of vasopressors during transport into the hospital and the patient died shortly after admission. 2 patients were transported to a hospital with ongoing CPR with manual as well as mechanical chest compressions (load distributing band CPR, AutoPulse® device, ZOLL, Chelmsford, MA, USA). In both cases, CPR attempts were terminated in the emergency department of the admitting hospital, based on further examination and laboratory results by the hospital physicians. In 5 cases (50%), resuscitation was unsuccessful and the patients died at the scene.Figure 2

Bottom Line: 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).The use of mechanical chest compression devices might result in higher rSO2.These findings need to be confirmed by larger studies.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, University of Bonn Medical Center, Sigmund-Freud-Str, 25, Bonn, 53105, Germany. marcus.thudium@ukb.uni-bonn.de.

ABSTRACT

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.

Show MeSH
Related in: MedlinePlus