Cerebral oximetry: a developing tool for monitoring cerebral oxygenation during cardiopulmonary resuscitation

2021 ◽  
Author(s):  
Elise L. Huppert ◽  
Sam Parnia
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cerebral Oxygenation ◽  
Cerebral Oximetry

scholarly journals Effects of Acute Bleeding Followed by Hydroxyethyl Starch 130/0.4 or a Crystalloid on Propofol Concentrations, Cerebral Oxygenation, and Electroencephalographic and Haemodynamic Variables in Pigs

2014 ◽  
Vol 2014 ◽  
pp. 1-12 ◽  
Author(s):  
Aura Silva ◽  
Ana Liza Ortiz ◽  
Carlos Venâncio ◽  
Almir P. Souza ◽  
Luísa Maria Ferreira ◽  
...  
Keyword(s):  
Cardiac Output ◽  
Hydroxyethyl Starch ◽  
Cerebral Oxygenation ◽  
Plasma Concentrations ◽  
Volume Replacement ◽  
Cerebral Oximetry ◽  
Total Power ◽  
Organ Perfusion ◽  
Acute Bleeding ◽  
Young Pigs

Bleeding changes the haemodynamics, compromising organ perfusion. In this study, the effects of bleeding followed by replacement with hydroxyethyl starch 130/0.4 (HES) or lactated Ringer’s (LR) on cerebral oxygenation and electroencephalogram-derived parameters were investigated. Twelve young pigs under propofol-remifentanil anaesthesia were bled 30 mL/kg and, after a 20-minute waiting period, volume replacement was performed with HES (GHES;N=6) or LR (GRL;N=6). Bleeding caused a decrease of more than 50% in mean arterial pressure (P<0.01) and a decrease in cerebral oximetry (P=0.039), bispectral index, and electroencephalogram total power (P=0.04andP<0.01, resp.), while propofol plasma concentrations increased (P<0.01). Both solutions restored the haemodynamics and cerebral oxygenation similarly and were accompanied by an increase in electroencephalogram total power. No differences between groups were found. However, one hour after the end of the volume replacement, the cardiac output (P=0.03) and the cerebral oxygenation (P=0.008) decreased in the GLRand were significantly lower than in GHES(P=0.02). Volume replacement with HES 130/0.4 was capable of maintaining the cardiac output and cerebral oxygenation during a longer period than LR and caused a decrease in the propofol plasma concentrations.

scholarly journals Asphyxiated Female and Male Newborn Piglets Have Similar Outcomes With Different Cardiopulmonary Resuscitation Interventions

2020 ◽  
Vol 8 ◽  
Author(s):  
Seung Yeon Kim ◽  
Gyu-Hong Shim ◽  
Megan O'Reilly ◽  
Po-Yin Cheung ◽  
Tze-Fun Lee ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cerebral Oxygenation ◽  
Secondary Analysis ◽  
Spontaneous Circulation ◽  
Male And Female ◽  
Newborn Piglets ◽  
Sustained Inflation ◽  
Significant Difference ◽  
Tissue Homogenates ◽  
Males And Females

Background: Male newborns have a greater risk of poor cardiovascular and respiratory outcomes compared to females. The mechanisms associated with the “male disadvantage” remains unclear. We have previously shown no difference between male and female newborn piglets during hypoxia, asphyxia, resuscitation, and post-resuscitation recovery. However, it is unknown if there are differences in resuscitation outcomes between males and females during different cardiopulmonary resuscitation techniques.Intervention and Measurements: Secondary analysis of 184 term newborn mixed breed duroc piglets (1–3 days of age, weighing 2.0 (0.2) kg) from seven different studies, which were exposed to 30–50 min of normocapnic hypoxia followed by asphyxia until asystole. This was followed by cardiopulmonary resuscitation. For the analysis, piglets were divided into male and female groups, as well as resuscitation technique groups (sustained inflation, 3:1 compression-to-ventilation ratio, or asynchronous ventilations during chest compressions). Cardiac function, carotid blood flow, and cerebral oxygenation were continuously recorded throughout the experiment.Main results: Regardless of resuscitation technique, there was no significant difference between males and females in the number achieving return of spontaneous circulation (ROSC) [95/123 (77%) vs. 48/61 (79%)], the time to achieve ROSC [112 (80–185) s vs. 110 (77–186) s], and the 4-h survival rate [81/95 (85%) vs. 40/48 (83%)]. Levels of the injury markers interleukin (IL)−1ß, IL-6, IL-8, and tumor necrosis factor-α in frontoparietal cortex tissue homogenates were similar between males and females.Conclusions: Regardless of resuscitation technique, there was no significant effect of sex on resuscitation outcome, survival, and hemodynamic recovery in asphyxiated newborn piglets.

scholarly journals Epinephrine’s effects on cerebrovascular and systemic hemodynamics during cardiopulmonary resuscitation

Critical Care ◽  
2020 ◽  
Vol 24 (1) ◽  
Author(s):  
Constantine D. Mavroudis ◽  
Tiffany S. Ko ◽  
Ryan W. Morgan ◽  
Lindsay E. Volk ◽  
William P. Landis ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Animal Studies ◽  
Tissue Oxygenation ◽  
Cerebral Oxygenation ◽  
Acute Effect ◽  
Correlation Spectroscopy ◽  
Neurological Injury ◽  
Swine Model ◽  
Cerebral Tissue ◽  
Cerebral Tissue Oxygenation

Abstract Background Despite controversies, epinephrine remains a mainstay of cardiopulmonary resuscitation (CPR). Recent animal studies have suggested that epinephrine may decrease cerebral blood flow (CBF) and cerebral oxygenation, possibly potentiating neurological injury during CPR. We investigated the cerebrovascular effects of intravenous epinephrine in a swine model of pediatric in-hospital cardiac arrest. The primary objectives of this study were to determine if (1) epinephrine doses have a significant acute effect on CBF and cerebral tissue oxygenation during CPR and (2) if the effect of each subsequent dose of epinephrine differs significantly from that of the first. Methods One-month-old piglets (n = 20) underwent asphyxia for 7 min, ventricular fibrillation, and CPR for 10–20 min. Epinephrine (20 mcg/kg) was administered at 2, 6, 10, 14, and 18 min of CPR. Invasive (laser Doppler, brain tissue oxygen tension [PbtO2]) and noninvasive (diffuse correlation spectroscopy and diffuse optical spectroscopy) measurements of CBF and cerebral tissue oxygenation were simultaneously recorded. Effects of subsequent epinephrine doses were compared to the first. Results With the first epinephrine dose during CPR, CBF and cerebral tissue oxygenation increased by > 10%, as measured by each of the invasive and noninvasive measures (p < 0.001). The effects of epinephrine on CBF and cerebral tissue oxygenation decreased with subsequent doses. By the fifth dose of epinephrine, there were no demonstrable increases in CBF of cerebral tissue oxygenation. Invasive and noninvasive CBF measurements were highly correlated during asphyxia (slope effect 1.3, p < 0.001) and CPR (slope effect 0.20, p < 0.001). Conclusions This model suggests that epinephrine increases CBF and cerebral tissue oxygenation, but that effects wane following the third dose. Noninvasive measurements of neurological health parameters hold promise for developing and directing resuscitation strategies.

scholarly journals Cerebral oximetry during extracorporeal cardiopulmonary resuscitation

Critical Care ◽  
2013 ◽  
Vol 17 (1) ◽  
pp. 409 ◽  
Author(s):  
Fabio Taccone ◽  
David Fagnoul ◽  
Benoit Rondelet ◽  
Jean-Louis Vincent ◽  
Daniel de Backer
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Cerebral Oximetry ◽  
Extracorporeal Cardiopulmonary Resuscitation

Cerebral Oxygen Saturation in Sickle Cell Patients Treated with Hydroxyurea:.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 1677-1677
Author(s):  
Masoud Nahavandi ◽  
Fatemeh Tavakkoli ◽  
Melville Q. Wyche ◽  
Syed P. Hasan ◽  
Oswaldo Castro
Keyword(s):  
Sickle Cell Disease ◽  
Oxygen Saturation ◽  
Sickle Cell ◽  
Cerebral Oxygenation ◽  
Cerebral Oximetry ◽  
Cerebral Oxygen Saturation ◽  
Cerebral Oxygen ◽  
Cell Disease ◽  
Non Invasive

Abstract Recently we reported the use of a non-invasive near-infrared optical spectroscopy technique to measure cerebral oxygenation (cerebral oximetry, rSO2%) in agroup of 27 adult patients with sickle cell disease (Eur J Clin Invest, 34:143,2004). The sickle cell patients’ rSO2 values were significantly lower (mean 47.7%) than those in normal subjects (mean 61.3%) even though none of the patients had clinical evidence of stroke or cerebral ischemia. We included patients with all Hb phenotypes, and regardless of hydroxyurea (HU) treatment. Transfusions improved cerebral oxygen saturation but the post-transfusion values still did not reach normal levels. Our findings were corroborated independently by Raj et al. who studied 25 children with sickle cell disease (J Pediat Hematol Oncol 26:279,2004). In order to determine if long-term HU treatment affects rSO2, we analyzed cerebral oximetry results in a subset of 31 patients with sickle cell anemia (Hb SS). Eleven of them were on long-term (more than 6 months) HU treatment at stable doses (1000–1500 mg/day). The table shows that the mean rSO2, Hb, Hct, and MCV in HU-treated patients were significantly higher than those in sickle cell anemia (SCA) patients not on HU. The rSO2 in HU-treated patients was 12.5% higher than in SS patients not on this drug. By comparison, we previously reported a 24% increment in rSO2 following transfusions. A group of 8 patients who were on long-term HU treatment were given also single 1000 mg oral doses of HU and their rSO2 was measured for 12 hours without noticeable change in cerebral oxygenation. Nor did rSO2 change after oxygen inhalation (3L/min). The cause of the low rSO2 in sickle cell patients is unknown and still under investigation. It is probably not related exclusively to the anemia, since, as previously reported, anemic subjects without sickle cell disease appear to have normal rSO2. These preliminary results indicate that chronic HU treatment is associated with higher rSO2 values in SCA. If validated in a larger number of patients, our findings suggest that cerebral oximetry could be a useful, non-invasive method for assessing a new in vivo effect of HU and red cell transfusion in sickle cell disease: increased blood oxygen saturation in the cerebral vasculature. HYDROXYUREA AND CEREBRAL OXYGEN SATURATION IN PATIENTS WITH SICKLE CELL DISEASE NO HYDROXYUREA (N=20) HYDROXYUREA (N=11) P value* rSO2 = cerebral oxygen saturation. *= t-test. Plus/minus figures represent SD Mean rSO2 (%) 41 ± 6.6 46 ± 7.6 0.025 Mean Hb (g/dl) 8.4 ± 1.4 9.68 ± 1.2 0.029 Mean Hct (%) 24± 3.4 28± 4.4 0.027 Mean MCV (fl) 89± 8 102± 7 0.028

Cerebral oximetry and stump pressure as indicators for shunting during carotid endarterectomy: comparative evaluation

Vascular ◽  
2011 ◽  
Vol 19 (4) ◽  
pp. 187-194 ◽  
Author(s):  
Charalambos L Tambakis ◽  
George Papadopoulos ◽  
Theodoros N Sergentanis ◽  
Nikolaos Lagos ◽  
Eleni Arnaoutoglou ◽  
...  
Keyword(s):  
Carotid Endarterectomy ◽  
Operating Characteristic ◽  
Internal Carotid ◽  
Cerebral Oxygenation ◽  
Cerebral Oximetry ◽  
Characteristic Analysis ◽  
Shunt Insertion ◽  
Stump Pressure ◽  
Baseline Recording ◽  
Cerebral Monitoring

The purpose of this work is to investigate the correlation between regional oxygen saturation (rSO2) changes and stump pressure (SP) during cross-clamping of the internal carotid artery in carotid endarterectomy (CEA) and verify the perspectives of rSO2 to become a criterion for shunting. Sixty consecutive CEAs under general anesthesia were studied prospectively. Selective shunting was based on SP ≤40 mmHg exclusively. Regression analysis with high order terms and receiver operating characteristic analysis were performed to investigate the association between ΔrSO2(%) and SP and to determine an optimal ΔrSO2(%) threshold for shunt insertion. A quadratic association between ΔrSO2(%) and SP was documented regarding the baseline to one and five minutes after cross-clamping intervals. A cut-off of 21 and 10.1% reduction from the baseline recording was identified as optimal for the distinction between patients needed or not a shunt regarding the first and fifth minute after cross-clamping, respectively. In conclusion, cerebral oximety reflects sufficiently cerebral oxygenation during CEA compared with SP, providing a useful mean for cerebral monitoring.

Low Cerebral Oxygenation Levels during Resuscitation in Out-of-hospital Cardiac Arrest Are Associated with Hyperfibrinolysis

2015 ◽  
Vol 123 (4) ◽  
pp. 820-829 ◽  
Author(s):  
Anne Duvekot ◽  
Victor A. Viersen ◽  
Simone E. Dekker ◽  
Leo M. G. Geeraedts ◽  
Lothar A. Schwarte ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Plasminogen Activator ◽  
Protein C ◽  
Tissue Oxygenation ◽  
Cerebral Oxygenation ◽  
Fibrinolytic System ◽  
Cerebral Tissue ◽  
Cerebral Tissue Oxygenation ◽  
Hospital Cardiac Arrest

Abstract Background: The authors investigated whether patients with out-of-hospital cardiac arrest with an initial low cerebral oxygen level during cardiopulmonary resuscitation are more prone to develop hyperfibrinolysis than patients with normal cerebral oxygenation levels and which part of the fibrinolytic system is involved in this response. Methods: In 46 patients, hyperfibrinolysis was diagnosed immediately upon emergency department admission using rotational thromboelastometry and defined as a lysis more than 15%. Simultaneously, initial cerebral tissue oxygenation was measured using near-infrared spectroscopy, and oxygen desaturation was defined as a tissue oxygenation index (TOI) of 50% or less. Blood sample analysis included markers for hypoperfusion and fibrinolysis. Results: There was no difference in prehospital cardiopulmonary resuscitation duration between patients with or without hyperfibrinolysis. An initial TOI of 50% or less was associated with more clot lysis (91% [17 to 100%; n = 16]) compared with patients with a normal TOI (6% [4 to 11%]; n = 30; P &lt; 0.001), with lower levels of plasminogen (151.6 ± 61.0 vs. 225.3 ± 47.0 μg/ml; P &lt; 0.001) and higher levels of tissue plasminogen activator (t-PA; 18.3 ± 7.4 vs. 7.9 ± 4.7 ng/ml; P &lt; 0.001) and plasminogen activator inhibitor-1 (19.3 ± 8.9 vs. 12.1 ± 6.1 ng/ml; P = 0.013). There were no differences in (activated) protein C levels among groups. The initial TOI was negatively correlated with t-PA (r = −0.69; P &lt; 0001). Mortality rates were highest in patients with hyperfibrinolysis. Conclusion: Activation of the fibrinolytic system is more common in out-of-hospital cardiac arrest patients with an initial cerebral tissue oxygenation value of 50% or less during resuscitation and is linked to increased levels of t-PA rather than involvement of protein C.

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