Relationship between the hemoglobin level at hospital arrival and post–cardiac arrest neurologic outcome

Nagao, Ken; Kikushima, Kimio; Sakamoto, Tetsuya; Koseki, Kazuhide; Igarashi, Masaki; Ishimatsu, Shinichi; Sato, Akira; Hori, Shingo; Kanesaka, Shigeru; Hamabe, Yuichi; Saito, Daizo; Kitamura, Shinya

doi:10.1016/j.ajem.2011.03.031

Cited by 34 publications

(17 citation statements)

References 17 publications

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“…Multivariate analyses revealed that the oxy-Hb value was a significant predictor of good neurologic outcomes in the entire cohort. AUC was significantly greater for oxy-Hb than for rSO 2 , Hb, and base excess, which were independently shown to be associated with neurologic outcomes [23,24]. Moreover, our results revealed that the oxy-Hb level determined in the immediate post-ROSC period could reflect the severity of neuroprotection, even in a subgroup of patients with ROSC before hospital arrival.…”

Section: Discussionmentioning

confidence: 57%

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

et al. 2014

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IntroductionLittle is known about oxyhemoglobin (oxy-Hb) levels in the cerebral tissue during the development of anoxic and ischemic brain injury. We hypothesized that the estimated cerebral oxy-Hb level, a product of Hb and regional cerebral oxygen saturation (rSO2), determined at hospital arrival may reflect the level of neuroprotection in patients with post-cardiac arrest syndrome (PCAS).MethodsThe Japan Prediction of neurological Outcomes in patients with Post cardiac arrest (J-POP) registry is a prospective, multicenter, cohort study to test whether rSO2 predicts neurologic outcomes after out-of-hospital cardiac arrest (OHCA). This study assessed a subgroup of consecutive patients who fulfilled the J-POP registry criteria and successfully achieved return of spontaneous circulation (ROSC) from OHCA. The primary outcome measure was the neurologic status at 90 days.ResultsWe analyzed data from 495 consecutive comatose survivors who were successfully resuscitated from OHCA, including 119 comatose patients with prehospital return of spontaneous circulation (ROSC; 24.0%) and 376 cardiac arrests at hospital arrival. In total, 75 patients (15.1%) presented with good neurologic outcomes. Univariate analysis revealed that the cerebral oxy-Hb levels were significantly higher in patients with good outcomes. Multivariate logistic regression using the backward-elimination method confirmed that the oxy-Hb level was a significant predictor of good neurologic outcomes (adjusted odds ratio, 1.27; 95% confidence interval (CI), 1.11 to 1.46). Analysis of the area under the receiver operating characteristic curve (AUC) revealed that an oxy-Hb cut-off of 5.5 provided optimal sensitivity and specificity for predicting good neurologic outcomes (AUC, 0.87; 95% CI, 0.83 to 0.91; sensitivity, 77.3%; specificity, 85.6%). The oxy-Hb level appeared to be an excellent prognostic indicator with significant advantages over rSO2 and base excess, according to AUC analysis. The significant trend for good neurologic outcomes was consistent, even in the subgroup of patients who achieved return of spontaneous circulation on hospital arrival (1st quartile, 0; 2nd quartile, 16.7%; 3rd quartile, 29.4%; 4th quartile, 53.3%; P < 0.05).ConclusionsThe cerebral oxy-Hb level may predict neurologic outcomes and is a simple and excellent indicator of neuroprotection in patients with PCAS.Trial registrationUMIN Clinical Trials Registry UMIN000005065. Registered 1 April 2011.

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Section: Discussionmentioning

confidence: 57%

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

et al. 2014

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“…We found no studies that investigated the relationship between hemoglobin level and neurological outcomes after ECPR. Initial hemoglobin level is reported as important for neurological outcomes after conventional CPR [12]. The SOS-KANTO study showed higher hemoglobin levels at hospital arrival are associated with favorable short-term neurological outcomes among postcardiac-arrest patients [12].…”

Section: Discussionmentioning

confidence: 99%

“…Initial hemoglobin level is reported as important for neurological outcomes after conventional CPR [12]. The SOS-KANTO study showed higher hemoglobin levels at hospital arrival are associated with favorable short-term neurological outcomes among postcardiac-arrest patients [12]. Animal studies also showed that the penumbral brain is more vulnerable than the normal brain, with oxygen delivery and cerebral metabolic rate progressively declining as hemoglobin concentration decreases [13,14].…”

Section: Discussionmentioning

confidence: 99%

Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation

et al. 2015

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BackgroundExtracorporeal cardiopulmonary resuscitation (ECPR) refers to use of extracorporeal membrane oxygenation (ECMO) in cardiopulmonary arrest. Although ECPR can increase survival rates after cardiac arrest, it can also result in poor post-resuscitation neurological status. Thus, we investigated predictors of good neurological outcomes after successful ECPR.MethodsA total of 227 patients underwent ECPR from May 2004 to June 2013 at Samsung Medical Center. Successful ECPR was defined as survival more than 24 hours after ECPR. Neurological outcomes were assessed at discharge using the Glasgow-Pittsburgh Cerebral Performance Categories scale (CPC). CPC 1 and 2 were classified as good and CPC 3 to 5 were classified as poor neurological outcomes. Excluded were 22 patients who did not survive more than 24 hours after ECPR and 90 patients who died from unknown causes or causes other than brain death or whose neurological status could not be assessed at discharge. Multiple logistic regression analysis was used to identify independent predictors of neurological outcomes.ResultsIncluded were 115 patients with a mean age of 58 (range 45–66) years and 80 men (70%). Cardiopulmonary resuscitation (CPR) was performed at non-hospital sites for 19 (17%) patients and bystander CPR was performed in 9 of 19 cases (47%). Cardiac etiology was verified in 74 (64%) patients and therapeutic hypothermia was performed in 9 patients (8%); 68 (59%) had good neurological outcomes and 47 (41%) did not and 24 patients died from brain death. Neurological outcomes were affected by hemoglobin levels before ECMO (P = 0.02), serum lactic acid (P < 0.001) before ECMO insertion, and interval from cardiac arrest to ECMO (P = 0.04).ConclusionsLow hemoglobin or high serum lactic acid levels before ECMO, and prolonged interval from cardiac arrest to ECMO predicted poor neurological outcomes after successful ECPR. Early institution of ECMO and a low threshold for blood transfusion might improve neurological outcomes for patients who survive ECPR.

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“…Nakao et al conducted a retrospective study of 137 subjects with witnessed CA and established that higher admission hemoglobin was an independent predictor of a 28-day favorable neurologic outcome (OR 1.26, 95% CI 1.00–1.58) [30]. These findings were corroborated by Wang et al, who demonstrated an association with adverse outcome and lower admission hemoglobin [31].…”

Section: Secondary Injurymentioning

confidence: 93%

Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model

2017

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Hypoxic ischemic brain injury (HIBI) after cardiac arrest (CA) is a leading cause of mortality and long-term neurologic disability in survivors. The pathophysiology of HIBI encompasses a heterogeneous cascade that culminates in secondary brain injury and neuronal cell death. This begins with primary injury to the brain caused by the immediate cessation of cerebral blood flow following CA. Thereafter, the secondary injury of HIBI takes place in the hours and days following the initial CA and reperfusion. Among factors that may be implicated in this secondary injury include reperfusion injury, microcirculatory dysfunction, impaired cerebral autoregulation, hypoxemia, hyperoxia, hyperthermia, fluctuations in arterial carbon dioxide, and concomitant anemia.Clarifying the underlying pathophysiology of HIBI is imperative and has been the focus of considerable research to identify therapeutic targets. Most notably, targeted temperature management has been studied rigorously in preventing secondary injury after HIBI and is associated with improved outcome compared with hyperthermia. Recent advances point to important roles of anemia, carbon dioxide perturbations, hypoxemia, hyperoxia, and cerebral edema as contributing to secondary injury after HIBI and adverse outcomes. Furthermore, breakthroughs in the individualization of perfusion targets for patients with HIBI using cerebral autoregulation monitoring represent an attractive area of future work with therapeutic implications.We provide an in-depth review of the pathophysiology of HIBI to critically evaluate current approaches for the early treatment of HIBI secondary to CA. Potential therapeutic targets and future research directions are summarized.

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Relationship between the hemoglobin level at hospital arrival and post–cardiac arrest neurologic outcome

Cited by 34 publications

References 17 publications

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

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

Predictors of neurological outcomes after successful extracorporeal cardiopulmonary resuscitation

Clinical pathophysiology of hypoxic ischemic brain injury after cardiac arrest: a “two-hit” model

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