Cerebral Oximetry During Cardiac Arrest
| Autor: | Charles D. Deakin, David Kitson, Pauline Bartlett, Kim Golder, David Pogson, Sarah Cooke, Adam J. Singer, Stephen J. Brett, Teresa Melody, Elinor Schoenfeld, Jerry P. Nolan, Nancy Wichtendahl, Jie Yang, Shreyas Ravishankar, Jiawen Zhu, Jianjin Xu, Robert T Nguyen, Gavin D. Perkins, Sam Parnia, Asad Nasir, Ken Spearpoint, Loren Inigo-Santiago, Barbara Mills, Anna Ahn, Christopher Walker, Paul Richman, Mehboob Chilwan |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Resuscitation medicine.medical_treatment Ischemia 1110 Nursing 030204 cardiovascular system & hematology Return of spontaneous circulation Critical Care and Intensive Care Medicine Brain Ischemia Brain ischemia 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Humans Oximetry Prospective Studies Cardiopulmonary resuscitation Intensive care medicine Prospective cohort study Survival rate Aged business.industry 1103 Clinical Sciences 030208 emergency & critical care medicine Middle Aged medicine.disease Emergency & Critical Care Medicine Cardiopulmonary Resuscitation Patient Discharge United Kingdom United States Heart Arrest Survival Rate Treatment Outcome 1117 Public Health And Health Services Cerebrovascular Circulation Predictive value of tests Cardiology Female business |
| Zdroj: | Critical Care Medicine. 44:1663-1674 |
| ISSN: | 0090-3493 |
| Popis: | OBJECTIVES\ud Cardiac arrest is associated with morbidity and mortality because of cerebral ischemia. Therefore, we tested the hypothesis that higher regional cerebral oxygenation during resuscitation is associated with improved return of spontaneous circulation, survival, and neurologic outcomes at hospital discharge. We further examined the validity of regional cerebral oxygenation as a test to predict these outcomes.\ud \ud DESIGN\ud Multicenter prospective study of in-hospital cardiac arrest.\ud \ud SETTING\ud Five medical centers in the United States and the United Kingdom.\ud \ud PATIENTS\ud Inclusion criteria are as follows: in-hospital cardiac arrest, age 18 years old or older, and prolonged cardiopulmonary resuscitation greater than or equal to 5 minutes. Patients were recruited consecutively during working hours between August 2011 and September 2014. Survival with a favorable neurologic outcome was defined as a cerebral performance category 1-2.\ud \ud INTERVENTIONS\ud Cerebral oximetry monitoring.\ud \ud MEASUREMENTS AND MAIN RESULTS\ud Among 504 in-hospital cardiac arrest events, 183 (36%) met inclusion criteria. Overall, 62 of 183 (33.9%) achieved return of spontaneous circulation, whereas 13 of 183 (7.1%) achieved cerebral performance category 1-2 at discharge. Higher mean ± SD regional cerebral oxygenation was associated with return of spontaneous circulation versus no return of spontaneous circulation (51.8% ± 11.2% vs 40.9% ± 12.3%) and cerebral performance category 1-2 versus cerebral performance category 3-5 (56.1% ± 10.0% vs 43.8% ± 12.8%) (both p < 0.001). Mean regional cerebral oxygenation during the last 5 minutes of cardiopulmonary resuscitation best predicted the return of spontaneous circulation (area under the curve, 0.76; 95% CI, 0.69-0.83); regional cerebral oxygenation greater than or equal to 25% provided 100% sensitivity (95% CI, 94-100) and 100% negative predictive value (95% CI, 79-100); regional cerebral oxygenation greater than or equal to 65% provided 99% specificity (95% CI, 95-100) and 93% positive predictive value (95% CI, 66-100) for return of spontaneous circulation. Time with regional cerebral oxygenation greater than 50% during cardiopulmonary resuscitation best predicted cerebral performance category 1-2 (area under the curve, 0.79; 95% CI, 0.70-0.88). Specifically, greater than or equal to 60% cardiopulmonary resuscitation time with regional cerebral oxygenation greater than 50% provided 77% sensitivity (95% CI,:46-95), 72% specificity (95% CI, 65-79), and 98% negative predictive value (95% CI, 93-100) for cerebral performance category 1-2.\ud \ud CONCLUSIONS\ud 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. |
| Databáze: | OpenAIRE |
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