Elevated jugular venous oxygen saturation after cardiac arrest

Richter, Jaromir; Sklienka, Peter; Chatterjee, Nilay; Máca, Jan; Záhorec, R; Burda, Michal

doi:10.1016/j.resuscitation.2021.10.011

Cited by 15 publications

(8 citation statements)

References 31 publications

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“…To the Editor, We have read with great interest the letter to the editor written by Dr Griesdale and Dr Sekhon, responding positively to our recent article regarding the association between high SjvO 2 values and unfavourable outcome. 1 We agree entirely with the view that we need to focus on mechanisms responsible for cerebral hypoxia, observed following cardiac arrest, specifically the possible impaired oxygen diffusion due to cerebral oedema.…”

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confidence: 75%

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2022

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supporting

confidence: 75%

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2022

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“…In two early studies [14,15], mean CBFV in the middle cerebral artery (MCA) decreased immediately after ROSC but returned to normal within 72 h with no difference between survivors and nonsurvivors. However, while in survivors, the cerebral oxygen extraction fraction (CEO 2 ) decreased slightly and returned towards normal values within 72 h, in nonsurvivors, the CEO 2 showed a significant decrease and remained low at 72 h. In line with these results, a recent study [16] showed supranormal levels (>75%) of jugular venous oxygen saturation in HIBI patients with poor neurological outcome and elevated brain injury biomarkers. Overall, these findings suggest that, following cardiac arrest, a reduction in CBF occurs, paralleled by a reduction in cerebral metabolism, which is more pronounced in patients with more severe HIBI.…”

Section: Monitoring Arterial Cerebral Blood Flowmentioning

confidence: 52%

Brain monitoring after cardiac arrest

Sandroni

Skrifvars

Taccone

2023

Current Opinion in Critical Care

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Purpose of reviewTo describe the available neuromonitoring tools in patients who are comatose after resuscitation from cardiac arrest because of hypoxic–ischemic brain injury (HIBI).Recent findingsElectroencephalogram (EEG) is useful for detecting seizures and guiding antiepileptic treatment. Moreover, specific EEG patterns accurately identify patients with irreversible HIBI. Cerebral blood flow (CBF) decreases in HIBI, and a greater decrease with no CBF recovery indicates poor outcome. The CBF autoregulation curve is narrowed and right-shifted in some HIBI patients, most of whom have poor outcome. Parameters derived from near-infrared spectroscopy (NIRS), intracranial pressure (ICP) and transcranial Doppler (TCD), together with brain tissue oxygenation, are under investigation as tools to optimize CBF in patients with HIBI and altered autoregulation. Blood levels of brain biomarkers and their trend over time are used to assess the severity of HIBI in both the research and clinical setting, and to predict the outcome of postcardiac arrest coma. Neuron-specific enolase (NSE) is recommended as a prognostic tool for HIBI in the current postresuscitation guidelines, but other potentially more accurate biomarkers, such as neurofilament light chain (NfL) are under investigation.SummaryNeuromonitoring provides essential information to detect complications, individualize treatment and predict prognosis in patients with HIBI.

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“…Given the discordance between rSO 2 and CBF, the next question that arises is, what are the implications for COx as a metric of autoregulation, particularly in HIBI? First, normal jugular S v O 2 is $70-75% in healthy subjects 7 but elevated in a subset of HIBI patients as demonstrated by Sekhon et al, 9 and Richter et al, 10 suggesting reduced O 2 EF. Under these conditions, the arterial-jugular SO 2 difference may converge irrespective of CBF (Figure 1), with CBF and oxygen utilization uncoupled.…”

Section: Nirs For Monitoring Cerebral Autoregulationmentioning

confidence: 91%

Shining a light on cerebral autoregulation: Are we anywhere near the truth?

Bird,

MacLeod,

Griesdale

et al. 2024

J Cereb Blood Flow Metab

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The near-infrared spectroscopy (NIRS)-derived cerebral oximetry index (COx) has become popularized for non-invasive neuromonitoring of cerebrovascular function in post-cardiac arrest patients with hypoxic-ischemic brain injury (HIBI). We provide commentary on the physiologic underpinnings and assumptions of NIRS and the COx, potential confounds in the context of HIBI, and the implications for the assessment of cerebral autoregulation.

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Elevated jugular venous oxygen saturation after cardiac arrest

Cited by 15 publications

References 31 publications

Reply to: “Correspondence to: Elevated jugular venous oxygen saturation after cardiac arrest”

Reply to: “Correspondence to: Elevated jugular venous oxygen saturation after cardiac arrest”

Brain monitoring after cardiac arrest

Shining a light on cerebral autoregulation: Are we anywhere near the truth?

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