2015 •
Pre-hospital cerebral oxygen saturation measurement in cardiac arrest patients under particular consideration of „Targeted Temperature Management“
Authors:
Trenkmann, Lars
Abstract:
In the context of the present work the regional cerebral oxygen saturation (rSO2) was measured during and subsequent to a cardiopulmonary resuscitation (CPR) as parameter potentially predicting the neurological outcome. In particular consideration was the ‘Targeted Temperature Management’ (TTM) with a target temperature of 33°C in this study. Previous studies showed rSO2 as parameter having the ability to represent changed cerebral perfusion and oxygenation. Regional cerebral oxygen saturation was measured by use of near infrared spectrosc (...)
In the context of the present work the regional cerebral oxygen saturation (rSO2) was measured during and subsequent to a cardiopulmonary resuscitation (CPR) as parameter potentially predicting the neurological outcome. In particular consideration was the ‘Targeted Temperature Management’ (TTM) with a target temperature of 33°C in this study. Previous studies showed rSO2 as parameter having the ability to represent changed cerebral perfusion and oxygenation. Regional cerebral oxygen saturation was measured by use of near infrared spectroscopy (NIRS) determining with infrared light the proportion of oxygenated to deoxygenated hemoglobin in a depth of about 2.5cm. The depicted values correspond to an arterio-venous oxygen saturation. A key component of this dissertation was the independent NIRS measurement on the emergency doctor´s vehicle 2505 of the Berlin fire department. In the framework of this study 29 patients with pre-hospital measurement of rSO2 were included. Continuous measurement was initiated under current reanimation or at the maximum two minutes after return of spontaneous circulation (ROSC) and was terminated at the end of therapeutic TTM. Simultaneously collected were the progress of body temperature, age, sex, initial rhythm, administered adrenalin dose, length of reanimation, hours on respirator, APACHE II score and the length of stay. At discharge neurological outcome was classified by ‘cerebral performance category’ (CPC). Retrospectively all patients (n=29) were divided into three groups (1. – good neurological out-come = CPC 1-2, three patients; 2. – bad neurological outcome = CPC 3-5, eight patients; 3. – no ROSC = CPC 5, 18 patients). Group 1 with good CPC (1-2) showed a rSO2 median of 23% (22 – 52%) being higher than that of the other group with 19% (15 – 42%). Average of rSO2 measured across the complete process (n=11) also was distinctly higher in patients with good outcome (71% (70 – 73%) vs. 63% (54 – 73%)). Patients with no ROSC (n=18) had a rSO2 median of 16.5% (IQR 15 – 29%). Two patients with CPC at discharge of 1-2 were included under reanimation. Their initial rSO2 were at 22% and 23%. In the comparison group (CPC 3-5) three patients could be included under CPR. Their initial values were at 15%, 16% and 46%. Patients with good outcome showed higher initial rSO2 values and also showed higher rSO2 values during the process. It appears that survival is possible with low initial rSO2 values. Probably the initial rSO2 values are not good outcome predictors. Due to the numerous factors influencing rSO2 and the small number of patients in this study further investigations of such collectives are necessary. (Read More)
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