Changes of Cerebral Oxygen Metabolism and Hemodynamics During ECPR with Hypothermia Measured by Near-Infrared Spectroscopy: A Pilot Study

Yagi, T.; Nagao, Ken; Sakatani, Kaoru; Kawamorita, Tsuyoshi; Soga, Taketomo; Kikushima, Kimio; Watanabe, Kazuhiro; Tachibana, Eizo; Tominaga, Yoshihiro; Tada, Kazuhiro; Ishii, Mitsuru; Chiba, Nobutaka; Nishikawa, Kei; Matsuzaki, Masunori; Hirose, H; Yoshino, Atsuo; Hirayama, Atsushi

doi:10.1007/978-1-4614-7411-1_17

Cited by 11 publications

(7 citation statements)

References 13 publications

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“…[24][25][26][27] Regional cerebral blood flow, most commonly represented by carotid blood flow or cerebral perfusion pressure, was found to have a strong correlation with cerebral oxygenation. 24,28,29 Similarly, coronary perfusion pressure, the most reliable indicator of myocardial perfusion, was found to correlate well with the ROSC and survival in both animal and clinical studies. [30][31][32][33][34][35] Given these findings, it was inferred that greater hemodynamic support in the setting of CPR could have significant incremental effects beyond standard ACLS treatment.…”

Section: Development Of Advanced Perfusion Strategiesmentioning

confidence: 79%

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

Aufderheide

Kalra

Kosmopoulos

et al. 2021

Annals of the New York Academy of Sciences

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Extracorporeal cardiopulmonary resuscitation (ECPR) is an emerging method of cardiopulmonary resuscitation to improve outcomes from cardiac arrest. This approach targets patients with out-of-hospital cardiac arrest previously unresponsive and refractory to standard treatment, combining approximately 1 h of standard CPR followed by venoarterial extracorporeal membrane oxygenation (VA-ECMO) and coronary artery revascularization. Despite its relatively new emergence for the treatment of cardiac arrest, the approach is grounded in a vast body of preclinical and clinical data that demonstrate significantly improved survival and neurological outcomes despite unprecedented, prolonged periods of CPR. In this review, we detail the principles behind VA-ECMO-facilitated resuscitation, contemporary clinical approaches with outcomes, and address the emerging new understanding of the process of death and capability for neurological recovery.

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Section: Development Of Advanced Perfusion Strategiesmentioning

confidence: 79%

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

Aufderheide

Kalra

Kosmopoulos

et al. 2021

Annals of the New York Academy of Sciences

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“…Two reports have shown a significant increase in the cerebral rSO 2 value after the application of ECPR in patients with OHCA; however, all of the reported patients had a poor neurological outcome or died [ 4 , 12 ]. One report showed that the tissue oxygen index decreased in a patient with a favourable neurological outcome ( n = 1) but that it did not change in patients with unfavourable neurological outcome ( n = 14) [ 13 ]. These reports also failed to show a relationship between the cerebral rSO 2 value during ECPR and the neurological outcome.…”

Section: Discussionmentioning

confidence: 99%

The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases

et al. 2017

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BackgroundIn recent years, the measurement of cerebral regional oxygen saturation (rSO2) during resuscitation has attracted attention. The objective of this study was to clarify the relationship between the serial changes in the cerebral rSO2 values during extracorporeal cardiopulmonary resuscitation (ECPR) and the neurological outcome.MethodsWe measured the serial changes in the cerebral rSO2 values of patients with out-of-hospital cardiac arrest before and after ECPR in Osaka National Hospital.ResultsFrom January 2013 through March 2015, the serial changes in the cerebral rSO2 values were evaluated in 16 patients. Their outcomes, as measured by the Glasgow Outcome Scale (GOS) score at discharge, included good recovery (GR) (n = 4), vegetative state (VS) (n = 2), and death (D) (n = 10). In the poor neurological group (VS and D: n = 12; age, 52.8 ± 4.0 years), the cerebral rSO2 values showed a significant increase during ECPR (5 min before ECPR: 52.0 ± 1.8%; 2 min before ECPR: 56.1 ± 2.3%; 2 min after ECPR: 63.5 ± 2.2%; 5 min after ECPR: 66.4 ± 2.2%; 10 min after ECPR: 67.6 ± 2.3% [P < 0.01]). In contrast, in the good neurological group (GR: n = 4; age, 53.8 ± 6.9 years), the cerebral rSO2 values did not increase to a significant extent during ECPR (5 min before ECPR: 61.9 ± 3.1%; 2 min before ECPR: 57.1 ± 4.0%; 2 min after ECPR: 59.6 ± 3.8%; 5 min after ECPR: 61.0 ± 3.7%; 10 min after ECPR: 62.0 ± 3.8% [P = 0.88]). Our study suggested that the patients whose cerebral rSO2 values showed no significant improvement after ECPR might have had a good neurological prognosis.ConclusionsThe serial changes in the cerebral rSO2 values during ECPR may predict a patient’s neurological outcome. The further evaluation of the validity of rSO2 monitoring during ECPR may lead to a new resuscitation strategy.

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“…However, we implemented ECPR in this case because the initial TOI was within the normal range ( 3 ). An initial regional cerebral oxygen saturation ≥40% predicts a favorable outcome in patients with CA ( 3 , 5 , 6 ). In our case, the TOI decreased just before ECPR implementation and increased to 55% immediately after that.…”

Section: Discussionmentioning

confidence: 99%

“…This higher TOI seemed to be caused by a decrease in the oxygen consumption of the injured neuronal cells and an increase in the oxygen carrying capacity due to ischemia-reperfusion. Yagi et al reported that a high initial TOI or continuously high TOI values during ECPR predict poor neurological outcomes ( 5 ). In the present case, the TOI values were not high but instead relatively low during the period after ECPR was discontinued, presumably because the oxygen consumption of the brain tissue was well-preserved.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Tissue Oxygenation Index Using Near-infrared Spectroscopy during Extracorporeal Cardio-pulmonary Resuscitation Predicted Good Neurological Recovery in a Patient with Acute Severe Anemia

et al. 2017

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We herein report the clinical course of a patient who had a good neurological outcome despite severe anemia, high serum lactate levels, and a long period of time from cardiac arrest (CA) to extracorporeal cardio-pulmonary resuscitation (ECPR) establishment. During the period of resuscitation, the tissue oxygenation index (TOI) values were measured continuously by a near-infrared spectroscopy monitoring device and were kept within the normal range. The TOI seems to reflect cerebral perfusion and the balance between the oxygen supply and demand in the brain during ECPR, thereby predicting the neurological outcome. Continuous TOI monitoring is useful for predicting the neurological outcome during ECPR.

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Changes of Cerebral Oxygen Metabolism and Hemodynamics During ECPR with Hypothermia Measured by Near-Infrared Spectroscopy: A Pilot Study

Cited by 11 publications

References 13 publications

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

Enhancing cardiac arrest survival with extracorporeal cardiopulmonary resuscitation: insights into the process of death

The relationship between cerebral regional oxygen saturation during extracorporeal cardiopulmonary resuscitation and the neurological outcome in a retrospective analysis of 16 cases

Cerebral Tissue Oxygenation Index Using Near-infrared Spectroscopy during Extracorporeal Cardio-pulmonary Resuscitation Predicted Good Neurological Recovery in a Patient with Acute Severe Anemia

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