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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Hazinski MF, Nolan JP, Billi JE et al (2010) International consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circ J 122:S250–S605
Field JM, Hazinski MF, Sayre MR et al (2010) American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circ J 122:S639–S946
SOS-KANTO Study Group (2007) Cardiopulmonary resuscitation by bystanders with chest compression only (SOS-KANTO): an observational study. Lancet 369(9565):920–926
SOS-KANTO Committee (2005) Incidence of ventricular fibrillation in patients with out-of-hospital cardiac arrest in Japan: survey of survivors after out-of-hospital cardiac arrest in Kanto area (SOSKANTO). Circ J 69(10):1157–1162
SOS-KANTO Study Group (2009) Comparison of arterial blood gases of laryngeal mask airway and bag-valve-mask ventilation in out-of-hospital cardiac arrests. Circ J 73(3):490–496
SOS-KANTO Study Group (2011) Atropine sulfate for patients with out-of-hospital cardiac arrest due to asystole and pulseless electrical activity. Circ J 75(3):580–588
The Hypothermia After Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcomes after cardiac arrest. N Engl J Med 346:549–556
Berrard SA, Gray TW, Buist MD et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346(8):557–563
Nagao K, Hayashi N, Kanmatsuse K et al (2000) Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol 36(3):776–783
Nagao K, Kikushima K, Watanabe K et al (2010) Early induction of hypothermia during cardiac arrest improves neurological outcomes in patients with out-of-hospital cardiac arrest who undergo emergency cardiopulmonary bypass and percutaneous coronary intervention. Circ J 74(1):77–85
Samra SK, Dorjie P, Zelenock GB, Stanley JC (1996) Cerebral oximetry in patients undergoing carotid endarterectomy under regional anesthesia. Stroke 27(1):49–55
Nakamura S, Kano T, Sakatani K et al (2009) Optical topography can predict occurrence of watershed infarction during carotid endarterectomy: technical case report. Surg Neurol 71(5):540–542
Cummins RO, Chamberlain DA, Abramson NS et al (1991) Recommended guidelines for uniform reporting of data from out-of-hospital cardiac arrest: the Utstein style – a statement for health professionals from a task force of the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, and the Australian Resuscitation Council. Circulation 84(2):960–975
Ito N, Nanto S, Nagao K, Hatanaka T, Nishiyama K, Kai T (2012) Regional cerebral oxygen saturation on hospital arrival is a potential novel predictor of neurological outcomes at hospital discharge in patients with out-of-hospital cardiac arrest. Resuscitation 83(1):46–50
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer Science+Business Media New York
About this paper
Cite this paper
Yagi, T. et al. (2013). Changes of Cerebral Oxygen Metabolism and Hemodynamics During ECPR with Hypothermia Measured by Near-Infrared Spectroscopy: A Pilot Study. In: Van Huffel, S., Naulaers, G., Caicedo, A., Bruley, D.F., Harrison, D.K. (eds) Oxygen Transport to Tissue XXXV. Advances in Experimental Medicine and Biology, vol 789. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-7411-1_17
Download citation
DOI: https://doi.org/10.1007/978-1-4614-7411-1_17
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-7256-8
Online ISBN: 978-1-4614-7411-1
eBook Packages: Biomedical and Life SciencesBiomedical and Life Sciences (R0)