Tsukasa Yagi1,2,3, Ken Nagao4, Kaoru Sakatani5, Tsuyoshi Kawamorita6, Taketomo Soga4,6, Kimio Kikushima4,6, Kazuhiro Watanabe4,6, Eizo Tachibana4,7, Yoshiteru Tominaga6, Katsushige Tada6, Ishii Mitsuru6, Nobutaka Chiba6, Kei Nishikawa4,6, Masakazu Matsuzaki4,6, Harumi Hirose4,6, Atsuo Yoshino6,8, Atsushi Hirayama9. 1. Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. ygt0108@livedoor.com. 2. Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan. ygt0108@livedoor.com. 3. Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan. ygt0108@livedoor.com. 4. Department of Cardiology, Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, Surugadai Nihon University Hospital, 1-8-13 Kanda Surugadai, Chiyoda-ku, Tokyo, 101-8309, Japan. 5. Department of Electrical and Electronics Engineering, Nihon University College of Engineering, Koriyama, Japan. 6. Department of Emergency and Critical Care Medicine, Surugadai Nihon University Hospital, Tokyo, Japan. 7. Department of Cardiology, Kawaguchi Municipal Medical Center, Kawaguchi, Japan. 8. Division of Neurosurgery, Department of Neurological Surgery, Nihon University School of Medicine, Tokyo, Japan. 9. Division of Cardiology, Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Abstract
BACKGROUND: The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS). METHODS: We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011. RESULTS: Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome. CONCLUSION: Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.
BACKGROUND: The 2010 CPR Guidelines recommend that extracorporeal cardiopulmonary resuscitation (ECPR) using an emergency cardiopulmonary bypass (CPB) should be considered for patients with cardiac arrest. However, it is not yet clear whether this therapy can improve cerebral circulation and oxygenation in these patients. To clarify this issue, we evaluated changes of cerebral blood oxygenation (CBO) during ECPR using near-infrared spectroscopy (NIRS). METHODS: We employed NIRS to measure CBO in the bilateral frontal lobe in patients transported to the emergency room (ER) after out-of-hospital cardiac arrest between November 2009 and June 2011. RESULTS: Fifteen patients met the above criteria. The tissue oxygenation index (TOI) on arrival at the ER was 36.5 %. This increased to 67.8 % during ECPR (P < 0.001). The one patient whose TOI subsequently decreased had a favorable neurological outcome. CONCLUSION: Increase of TOI during ECPR might reflect an improvement in cerebral blood flow, while decrease of TOI after ECPR might reflect oxygen utilization by the brain tissue as a result of neuronal cell survival. NIRS may be useful for monitoring cerebral hemodynamics and oxygen metabolism during CPR.
Authors: Tom P Aufderheide; Rajat Kalra; Marinos Kosmopoulos; Jason A Bartos; Demetris Yannopoulos Journal: Ann N Y Acad Sci Date: 2021-02-20 Impact factor: 5.691