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

Parnia, Sam; Yang, Jie; Nguyen, Robert; Ahn, Anna; Zhu, Jiawen; Inigo-Santiago, Loren; Nasir, Asad; Golder, Kim; Ravishankar, Shreyas; Bartlett, Pauline; Xu, Jianjin; Pogson, David; Cooke, Sarah; Walker, Christopher; Spearpoint, Ken; Kitson, David H.; Melody, Teresa; Chilwan, Mehboob; Schoenfeld, Elinor; Richman, Paul; Mills, Barbara G.; Wichtendahl, Nancy; Nolan, Jerry P.; Singer, Adam J.; Brett, Stephen; Perkins, Gavin D.; Deakin, Charles D.

doi:10.1097/ccm.0000000000001723

Cited by 102 publications

(34 citation statements)

References 23 publications

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“…However Storm et al [ 31 ] when investigating the effect of cerebral oxygenation during CPR found that a low value at the beginning of treatment on arrival of emergency services was not a good predictor of ROSC or neurological outcome. In contrast, Parnia et al [ 32 ] found that in IHCA, cerebral oxygenation values were a significant predictor of a neurologically favourable survival.…”

Section: Discussionmentioning

confidence: 92%

How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review

Welbourn

Efstathiou

2018

Scand J Trauma Resusc Emerg Med

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BackgroundBrain injury can occur after cardiac arrest due to the effects of ischaemia and reperfusion. In serious cases this can lead to permanent disability. This risk must be considered when making decisions about terminating resuscitation. There are very specific rules for termination of resuscitation in the prehospital setting however a similar rule for resuscitation in hospital does not exist. The aim of this review was to explore the effects of duration of cardiopulmonary resuscitation on neurological outcome in survivors of both in-hospital and out-of-hospital cardiac arrest achieving return of spontaneous circulation in hospital.MethodsA systematic review was conducted. Five databases were searched in addition to hand searching the journals Resuscitation and Circulation and reference lists, quality of the selected studies was assessed and a narrative summary of the data presented. Studies reporting relevant outcomes were included if the participants were adults achieving return of spontaneous circulation in the hospital setting. Studies looking at additional interventions such as extracorporeal resuscitation and therapeutic hypothermia were not included. Case studies were excluded. The study period was from January 2010 to March 2016.ResultsSeven cohort studies were included for review. Quality scores ranged from eight to 11 out of 12. Five of the studies found a significant association between shorter duration of resuscitation and favourable neurological outcome.ConclusionsThere is generally a better neurological outcome with a shorter duration of CPR in survivors of cardiac arrest however a cut-off beyond which resuscitation is likely to lead to unfavourable outcome could not be determined and is unlikely to exist. The findings of this review could be considered by clinicians making decisions about terminating resuscitation. This review has highlighted many gaps in the knowledge where future research is needed; a validated and reliable measure of neurological outcome following cardiac arrest, more focused research on the effects of duration on neurological outcome and further research into the factors leading to brain damage in cardiac arrest.Electronic supplementary materialThe online version of this article (10.1186/s13049-018-0476-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 92%

How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review

Welbourn

Efstathiou

2018

Scand J Trauma Resusc Emerg Med

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“…While methods exist for monitoring cerebral oxygen content perioperatively, no standardized method of continuous cerebral oxygen monitoring currently exists for patients undergoing an out-of-hospital (OHCA) or in-hospital CA (IHCA). Parnia and colleagues state that the ability to detect and quantify cerebral ischemia in real-time, during CPR is of vital clinical importance [ 85 ]. Patients, with a post-clinical determination of CA have suboptimal levels of cerebral oxygen content which may lead to secondary ischemic injuries (i.e., sterile inflammatory cascade).…”

Section: Brain Oxygen Monitoringmentioning

confidence: 99%

“…NIRS utilizes infrared light (700–1100 nm) to determine the difference in absorption between oxyhemoglobin and deoxyhemoglobin [ 91 ]. The use of near-infrared spectroscopy during CPR has produced multiple studies resulting in a correlation between higher regional oxygen saturation and a higher chance of return of spontaneous circulation [ 85 , 92 , 93 ]. However, another study indicated that the high regional oxygen saturation and possibility of return of spontaneous circulation was not significant to determine survivability to discharge [ 94 ].…”

Section: Brain Oxygen Monitoringmentioning

confidence: 99%

Pathophysiology and the Monitoring Methods for Cardiac Arrest Associated Brain Injury

Reis

Akyol

Araujo

et al. 2017

IJMS

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Cardiac arrest (CA) is a well-known cause of global brain ischemia. After CA and subsequent loss of consciousness, oxygen tension starts to decline and leads to a series of cellular changes that will lead to cellular death, if not reversed immediately, with brain edema as a result. The electroencephalographic activity starts to change as well. Although increased intracranial pressure (ICP) is not a direct result of cardiac arrest, it can still occur due to hypoxic-ischemic encephalopathy induced changes in brain tissue, and is a measure of brain edema after CA and ischemic brain injury. In this review, we will discuss the pathophysiology of brain edema after CA, some available techniques, and methods to monitor brain oxygen, electroencephalography (EEG), ICP (intracranial pressure), and microdialysis on its measurement of cerebral metabolism and its usefulness both in clinical practice and possible basic science research in development. With this review, we hope to gain knowledge of the more personalized information about patient status and specifics of their brain injury, and thus facilitating the physicians’ decision making in terms of which treatments to pursue.

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“…A higher rSO 2 or increases of rSO 2 have been shown to be strongly associated with ROSC and survival with favorable neurological outcome. [1][2][3][4] We have previously reported on the serial changes observed in cerebral rSO 2 values during resuscitation in patients with out-of-hospital cardiac arrest (OHCA). Although chest compression by itself could not increase the cerebral rSO 2 value, ROSC and the initiation of extracorporeal CPR increased the cerebral rSO 2 value.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of cerebral rSO2 monitoring during CPR to predict the probability of return of spontaneous circulation

et al. 2019

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Background: Cerebral oximetry (rSO 2) may be useful in assessing the probability of return of spontaneous circulation (ROSC). However, the potential of assessing the trend in the rSO 2 value has not been discussed when determining the probability of ROSC. Methods: This was a retrospective study of out-of-hospital cardiac arrest (OHCA) patients with continuous rSO 2 values recorded during cardiopulmonary arrest. We used logistic regression analysis at each time point to investigate the best subsets of rSO 2-related variables for ROSC, which included rSO 2 (baseline), the baseline value of rSO 2 ; amount of maximum rise, the maximum difference of rSO 2 from rSO 2 (baseline) over t minutes; DrSO 2 (t):(amount of maximum rise)/rSO 2 (baseline) over t minutes after hospital arrival. Results: Among the 90 included patients, 35 achieved ROSC. Area under the curve (AUC) analysis revealed that DrSO 2 over a 16-min measurement period was significantly higher than DrSO 2 measured over 4-, 8-, 12-, and 20-min periods. During this 16-min period, the subset showing the best AUC value was interaction of the amount of maximum rise and rSO 2 (baseline) rather than the amount of maximum rise or DrSO 2 alone (AUC = 0.91). Conclusions: The combination of rSO 2 (baseline) with the amount of maximum rise in rSO 2 value over time might be a new index for the prediction of ROSC that could be useful in guiding cardiopulmonary resuscitation. Further studies are needed to validate these findings.

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

Cited by 102 publications

References 23 publications

How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review

How does the length of cardiopulmonary resuscitation affect brain damage in patients surviving cardiac arrest? A systematic review

Pathophysiology and the Monitoring Methods for Cardiac Arrest Associated Brain Injury

Usefulness of cerebral rSO2 monitoring during CPR to predict the probability of return of spontaneous circulation

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