Estimated cerebral oxyhemoglobin as a useful indicator of neuroprotection in patients with post-cardiac arrest syndrome: a prospective, multicenter observational study

Hayashida, Kei; Nishiyama, Kei; Suzuki, Mitsuaki; Abe, Takayuki; Orita, Tomohiko; Ito, Noritoshi; Hori, Shingo

doi:10.1186/s13054-014-0500-6

Cited by 20 publications

(21 citation statements)

References 52 publications

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“…The main strength of this study is that rSo 2 data were collected throughout CPR for the purpose of studying the association between cerebral oxygenation with ROSC (11-16) and survival with favorable neurologic outcomes (17,18). The clinical utility of this study lies in identifying a real-time, noninvasive method to quantify cerebral oxygen delivery.…”

Section: Discussionmentioning

confidence: 99%

“…Although a number of small studies have indicated that ROSC is associated with higher rSo 2 during CPR in out-of-hospital CA (OHCA) and in-hospital CA (IHCA) (11)(12)(13)(14)(15)(16), they lacked the power to determine the accuracy and clinical utility of rSo 2 as a predictor of ROSC. Recently, a single rSo 2 measured on arrival to the emergency department was found to predict survival with favorable neurologic outcomes at 90 days after OHCA (17,18). However, a single rSo 2 is unlikely to reflect the overall balance between cerebral ischemia and oxygen delivery throughout CPR.…”

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confidence: 98%

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Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival*

Parnia

Yang

Nguyen

et al. 2016

Critical Care Medicine

102

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Cerebral oximetry allows real-time, noninvasive cerebral oxygenation monitoring during cardiopulmonary resuscitation. Higher cerebral oxygenation during cardiopulmonary resuscitation is associated with return of spontaneous circulation and neurologically favorable survival to hospital discharge. Achieving higher regional cerebral oxygenation during resuscitation may optimize the chances of cardiac arrest favorable outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 98%

Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival*

Parnia

Yang

Nguyen

et al. 2016

Critical Care Medicine

102

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“…It is increasingly evident that secondary injury leads to adverse neurologic outcome and identification of ongoing brain hypoxia after ROSC is imperative. Human studies have principally focussed on establishing links between decreased rSO2 as a surrogate marker of brain oxygenation and neurological outcome, but have yielded conflicting results in its predictive utility (30)(31)(32)(33). These conflicting results, along with technical limitations of NIRS have hindered its routine use in evaluating brain hypoxia post cardiac arrest.…”

Section: Discussionmentioning

confidence: 99%

The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest*

Sekhon

Gooderham

Menon

et al. 2019

Critical Care Medicine

111

110

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Objectives: In patients at risk of hypoxic ischemic brain injury following cardiac arrest, we sought to (i) characterize brain oxygenation and determine the prevalence of brain hypoxia, (ii) characterize autoregulation using the pressure reactivity index (PRx) and identify the optimal mean arterial pressure (MAPOPT), and (iii) assess the relationship between MAPOPT and brain tissue oxygenation (PbtO2). Design: Prospective interventional study. Setting: Quaternary intensive care unit. Patients: Adult patients with return to spontaneous circulation (ROSC) greater than 10 minutes and a post-resuscitation Glasgow Coma Score under 9 within 72 hours of cardiac arrest. Interventions: All patients underwent multimodal neuromonitoring which included: (i) PbtO2, (ii) intracranial pressure; (iii) jugular venous continuous oximetry (SjvO2); (iv) regional saturation of oxygen (rSO2) using near-infrared spectroscopy, and (iv) PRx based determination of MAPOPT, lower and upper limit of autoregulation. We additionally collected MAP, end tidal carbon dioxide (ETCO2) and temperature. All data were captured at 300 Hz using ICM+® brain monitoring software. Measurements and Main Results: Ten patients (7 males) were included with a median age 47 (range 20-71) and ROSC 22 minutes (12-36). The median duration of monitoring was 47 hours (15-88) and median duration from cardiac arrest to inclusion was 15 hours (6-44). The mean PbtO2 was 23 mmHg (SD 8) and the mean percentage of time with a PbtO2 below 20 mmHg was 38% (6-100). The mean PRx was 0.23 (0.27) and the percentage of time with a PRx greater than 0.3 was 50% (12-91). The mean MAPOPT, lower and upper of autoregulation were 89 mmHg (11), 82mmHg (8) and 96 mmHg (9), respectively. There was marked betweenpatient variability in the relationship between MAP and indices of brain oxygenation. As the patients' actual MAP approached MAPOPT, PbtO2 increased (p<0.001). This positive relationship did not persist when the actual MAP was above MAPOPT. Conclusions: Episodes of brain hypoxia in HIBI are frequent and perfusion within proximity of MAPOPT is associated with increased PbtO2. PRx can yield MAPOPT, lower and upper limit of autoregulation in patients following cardiac arrest.

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“…11,14,15 The SOS-KANTO study group reported favorable short-term neurological outcome in patients with higher post arrest hemoglobin level. Study patients in the good neurological outcome group had a median hemoglobin level of 14.4 g/dl vs. 12.8 g/dl in the bad outcome group.…”

Section: Discussionmentioning

confidence: 99%

The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest

et al. 2016

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Aims to explore the association between post return of spontaneous circulation (ROSC) hemoglobin level and survival with good neurological outcome following out-of-hospital cardiac arrest. Methods We studied adults with non-traumatic out-of-hospital cardiac arrest who achieved ROSC within 50 minutes of collapse. We quantified the association between post ROSC hemoglobin level and good neurological outcome (defined as Cerebral Performance Category score of 1or 2), using multivariate logistic regression analyses. The impact of Post ROSC hemoglobin level ≥ 10 g/dl and time varying hemoglobin level ≥ 10 g/dl on time to Survival with good outcome was assessed using Cox proportional hazard models. Results Of 931 cardiac arrest patients, 146 (16%) achieved ROSC and 30 survived to discharge with a good neurological outcome. Of those with post ROSC hemoglobin level ≥ 10 g/dl, 28% (27/98) had good outcome, whereas of those with level < 10 mg/dl only 6% (3/48) had good outcome (CPC < 3, p=0.003). The use of blood transfusions and therapeutic hypothermia were comparable in both good and bad outcome groups. An immediate post ROSC hemoglobin level ≥ 10 g/dl was significantly associated with good neurological outcome (AOR 8.31 95% CI 1.89–36.52 p=0.005). Patients with post ROSC hemoglobin ≥ 10 g/dl were more likely to achieve good outcome earlier (HR 6.02 95% CI 1.75–20.72 p=0.004). Conclusions Post ROSC hemoglobin level ≥ 10 g/dl is associated with survival with good neurological outcome. The importance of time to achieve such level and the role of blood transfusion warrants further investigation.

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Estimated cerebral oxyhemoglobin as a useful indicator of neuroprotection in patients with post-cardiac arrest syndrome: a prospective, multicenter observational study

Cited by 20 publications

References 52 publications

Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival*

Cerebral Oximetry During Cardiac Arrest: A Multicenter Study of Neurologic Outcomes and Survival*

The Burden of Brain Hypoxia and Optimal Mean Arterial Pressure in Patients With Hypoxic Ischemic Brain Injury After Cardiac Arrest*

The association between post resuscitation hemoglobin level and survival with good neurological outcome following Out Of Hospital cardiac arrest

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