Abstract 124: A Pilot Study Examining Survival and the Balance Between Oxygen Delivery and Uptake in the Brain in the First 24 and 48 Hours Following Return of Spontaneous Circulation from Cardiac Arrest
Current literature has highlighted the importance of the optimization of organ perfusion and in particular the balance between oxygen delivery and uptake during cardiac arrest. While jugular venous oxygen saturation (SjO2) monitoring is considered the gold standard in determining the balance between cerebral oxygen delivery and oxygen uptake, it is an invasive test, which greatly limits its practical application. A non-invasive technology that has emerged and has been utilized in cardiac arrest to a limited extent is cerebral oximetry using near infrared spectroscopy (NIRS). However, to date there have been no studies incorporating the use of this technology in the evaluation of cerebral oxygen changes and their relationship with survival during the post resuscitation period.
Methods: In this pilot observational study we evaluated the use of NIRS in determining the changes that take place in regional cerebral oxygen saturation (rSO2) in the first 24 and 48 hours following return of spontaneous circulation (ROSC) and their relationship with survival to discharge. Data was collected from a series of 15 patients admitted to the CCU or ICU following return of spontaenous circulation (ROSC) and expressed as mean ±SD using cerebral oximetry (Equanox, Nonin, USA).
Results: 33% (n=5) patients died and 67%, n=10 remained alive to discharge. At baseline there was a small but significant increase in mean rSO2 for all patients between 24 and 48 hours following ROSC (67±3 at 24hrs and 71±5 at 48 hrs p=0.003). There was a significantly higher mean rSO2 at 24 hours (70±6 vs. 60±9 p<0.05) in patients who survived to discharge compared to those who did survive. There was however no significant difference in rSO2 between the two groups at 48 hours (72±3 vs. 67±11 p=0.2).
Conclusions: Our data indicate that cerebral oximetry can be used as a non-invasive test to evaluate changes in the balance between cerebral oxygen delivery and uptake during the post resuscitation period. Determining the optimal cerebral oxygen level may potentially enable the optimization of oxygen delivery and may aid in improving outcomes and prognostication. Further studies are needed to determine the optimal level of cerebral oxygen levels in the post-resuscitation period.
- © 2012 by American Heart Association, Inc.