Can Cerebral Regional Oxygen Saturation (rSO2) Be Used as an Indicator of the Quality of Chest Compressions in Patients With Cardiopulmonary Arrest? A Study Evaluating the Association Between rSO2 and Mean Arterial Pressure: the PRESS Study

Abstract Background: Sudden cardiac arrest causes numerous deaths worldwide. High-quality chest compressions are important for good neurological recovery. Arterial pressure is considered useful to monitor the quality of chest compressions by the American Heart Association. However, arterial pressure catheter might be inconvenient during resuscitation. Conversely, cerebral regional oxygen saturation (rSO2) during resuscitation may be associated with a good neurological prognosis. Therefore, we aimed to evaluate the correlation between mean arterial pressure and rSO2 during resuscitation to use rSO2 as the indicator of the quality of chest compressions.Methods: This study was a single-centre, prospective, observational study. Patients with out-of-hospital cardiac arrest who were transported to a tertiary care emergency centre between October 2014 and March 2015 in Japan were included. The primary outcome was the regression coefficient between MAP and rSO2. MAP and rSO2 were measured during resuscitation (at hospital arrival [0 min], 3 min, 6 min, 9 min, 12 min, 15 min), and MAP was measured by an arterial catheter inserted into the femoral artery. For analysis, we used the higher value of rSO2 obtained from the left and right forehead of the patient and measured using a near-infrared spectrometer. Regression coefficients were calculated using the generalized estimating equation (GEE) with MAP and SAP as response variables and rSO2 as an explanatory variable, because MAP and rSO2 were repeatedly measured in the same patient. Since the confounding factors between MAP or SAP and rSO2 were not clear clinically or from previous studies, the GEE was analysed using univariate analysis.Results: Thirty-seven patients were analysed. rSO2 and MAP during resuscitation from hospital arrival to 15 min later were expressed as follows (median [interquartile range]): rSO2, 29.5 (24.3–38.8) %, and MAP, 36.5 (26–46) mmHg. The regression coefficient (95% confidence interval) of log-rSO2 and log-MAP was 0.42 (0.03–0.81) (p=0.035).Conclusion: rSO2 and MAP showed a mild but statistically significant association. rSO2 could be used to assess the quality of chest compressions during resuscitation as a non-invasive and simple method.Trial registration: This study was registered in the University hospital Medical Information Network Clinical Trials Registry (UMIN000015479).

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Can Cerebral Regional Oxygen Saturation (rSO2) be used as an Indicator of the Quality of Chest Compressions in Patients with Cardiopulmonary Arrest? A Study Evaluating The Association between rSO2 and Mean Arterial Pressure: The PRESS Study

10.21203/rs.3.rs-923130/v2 ◽

2021 ◽

Author(s):

Yuki Kishihara ◽

Hideto Yasuda ◽

Masahiro Kashiura ◽

Naoshige Harada ◽

Takashi Moriya

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Oxygen Saturation ◽

Regression Coefficient ◽

Chest Compressions ◽

Simple Method ◽

Hospital Arrival ◽

Regional Oxygen Saturation

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Faculty Opinions recommendation of The burden of brain hypoxia and optimal mean arterial pressure in patients with hypoxic ischemic brain injury after cardiac arrest.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.735358901.793560884 ◽

2019 ◽

Author(s):

Mark Nunnally

Keyword(s):

Cardiac Arrest ◽

Brain Injury ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Ischemic Brain Injury ◽

Ischemic Brain ◽

Brain Hypoxia ◽

Hypoxic Ischemic Brain Injury

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Higher achieved mean arterial pressure during therapeutic hypothermia is not associated with neurologically intact survival following cardiac arrest

Resuscitation ◽

10.1016/j.resuscitation.2014.12.008 ◽

2015 ◽

Vol 88 ◽

pp. 158-164 ◽

Cited By ~ 20

Author(s):

Michael N. Young ◽

Ryan D. Hollenbeck ◽

Jeremy S. Pollock ◽

Jennifer L. Giuseffi ◽

Li Wang ◽

...

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Therapeutic Hypothermia ◽

Neurologically Intact

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Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21001084 ◽

2021 ◽

pp. 1-6

Author(s):

Chuenruthai Angkoontassaneeyarat ◽

Chaiyaporn Yuksen ◽

Chetsadakon Jenpanitpong ◽

Pemika Rukthai ◽

Marisa Seanpan ◽

...

Keyword(s):

Health Care ◽

Emergency Medicine ◽

Cardiac Arrest ◽

Cardiopulmonary Resuscitation ◽

Health Care Providers ◽

Care Providers ◽

Chest Compressions ◽

Threatening Condition ◽

Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

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Abstract 9934: High Mean Arterial Pressure Aggravates Cerebral Hemodynamics After Extracorporeal Resuscitation in Swine

Circulation ◽

10.1161/circ.144.suppl_2.9934 ◽

2021 ◽

Vol 144 (Suppl_2) ◽

Author(s):

Yael Levy ◽

Alice Hutin ◽

Nicolas Polge ◽

fanny lidouren ◽

Matthias Kohlhauer ◽

...

Keyword(s):

Blood Flow ◽

Cardiac Arrest ◽

Oxygen Consumption ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Cerebral Hemodynamics ◽

Reactivity Index ◽

Extracorporeal Cardiopulmonary Resuscitation ◽

Standard Map ◽

Arterial Blood

Introduction: Extracorporeal cardiopulmonary resuscitation (E-CPR) is used for the treatment of refractory cardiac arrest but the optimal target to reach for mean arterial pressure (MAP) remains to be determined. Hypothesis: We hypothesized that MAP levels modify cerebral hemodynamics during E-CPR. Accordingly, we tested two MAP targets (65-75 vs 80-90 mmHg) in a porcine model of E-CPR. Methods: Pigs were anesthetized and instrumented for the evaluation of cerebral and systemic hemodynamics. They were submitted to 15 min of untreated ventricular fibrillation followed by 30 min of E-CPR. Electric attempts of defibrillation were then delivered until resumption of spontaneous circulation (ROSC). Extracorporeal circulation was initially set to an average flow of 40 ml/kg/min with a standardized volume expansion in both groups. The dose of epinephrine was set to reach either a standard or a high MAP target level (65-75 vs 80-90 mmHg, respectively). Animals were followed during 120 min after ROSC. Results: Six animals were included in both groups. After cardiac arrest, MAP was maintained at the expected level (Figure). During E-CPR, high MAP transiently improved carotid blood flow as compared to standard MAP. This blood flow progressively decreased after ROSC in high vs standard MAP, while intra-cranial pressure increased. Interestingly, this was associated with a significant decrease in cerebral oxygen consumption (26±8 vs 54±6 L O 2 /min/kg at 120 min after ROSC, respectively; p<0.01) (Figure). The pressure reactivity index (PRx), which is the correlation coefficient between arterial blood pressure and intracranial pressure, became positive in high MAP (0.47±0.02) vs standard MAP group (-0.16±0.10), demonstrating altered cerebral autoregulation with high MAP. Conclusion: Increasing MAP above 80 mmHg with epinephrine aggravates cerebral hemodynamics after E-CPR. Figure: Mean arterial pressure (MAP), cerebral blood flow and oxygen consumption (*, p<0.05)

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Targeting low-normal or high-normal mean arterial pressure after cardiac arrest and resuscitation: a randomised pilot trial

Intensive Care Medicine ◽

10.1007/s00134-018-5446-8 ◽

2018 ◽

Vol 44 (12) ◽

pp. 2091-2101 ◽

Cited By ~ 41

Author(s):

Pekka Jakkula ◽

◽

Ville Pettilä ◽

Markus B. Skrifvars ◽

Johanna Hästbacka ◽

...

Keyword(s):

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Pilot Trial ◽

Normal Mean

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Mean arterial pressure during targeted temperature management and renal function after out-of-hospital cardiac arrest

Journal of Critical Care ◽

10.1016/j.jcrc.2018.12.009 ◽

2019 ◽

Vol 50 ◽

pp. 234-241 ◽

Cited By ~ 10

Author(s):

Johannes Grand ◽

Christian Hassager ◽

Matilde Winther-Jensen ◽

Malin Rundgren ◽

Hans Friberg ◽

...

Keyword(s):

Renal Function ◽

Cardiac Arrest ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Targeted Temperature Management ◽

Temperature Management ◽

Hospital Cardiac Arrest

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Cerebral Oxygen Saturation Measured by Near-infrared Spectroscopy and Jugular Venous Bulb Oxygen Saturation during Arthroscopic Shoulder Surgery in Beach Chair Position under Sevoflurane-Nitrous Oxide or Propofol-Remifentanil Anesthesia

Anesthesiology ◽

10.1097/aln.0b013e31825154d2 ◽

2012 ◽

Vol 116 (5) ◽

pp. 1047-1056 ◽

Cited By ~ 64

Author(s):

Hyejin Jeong ◽

Seongtae Jeong ◽

Hoi J. Lim ◽

JongUn Lee ◽

Kyung Y. Yoo

Keyword(s):

Nitrous Oxide ◽

Mean Arterial Pressure ◽

Arterial Pressure ◽

Oxygen Saturation ◽

Cerebral Oxygenation ◽

Shoulder Surgery ◽

Tissue Oxygen Saturation ◽

Beach Chair Position ◽

Beach Chair ◽

Jugular Venous Bulb

Background We examined the effects of different anesthetics on cerebral oxygenation and systemic hemodynamics in patients undergoing surgery in beach chair position (BCP). Jugular venous bulb oxygen saturation (SjvO2) and regional cerebral tissue oxygen saturation (SctO2) were determined while patients were placed from the supine to BCP. Whether SctO2 and SjvO2 are interchangeable in assessing the cerebral oxygenation was also examined. Methods Forty patients undergoing shoulder surgery in BCP were randomly assigned to receive sevoflurane-nitrous oxide (S/N) or propofol-remifentanil (P/R) anesthesia. Four patients taking angiotensin II receptor antagonists were excluded post hoc. Mean arterial pressure and heart rate, as well as SjvO2 and SctO2, were measured before (postinduction baseline in supine position) and after BCP. Results Mean arterial pressure decreased by BCP in both groups. It was, however, significantly higher in S/N (n = 19) than in P/R group (n = 17) at 7 to 8 min after the positioning. SjvO2 also significantly decreased after BCP in both groups, the magnitude of which was lower in S/N than in P/R group (11 ± 10% vs. 23 ± 9%, P = 0.0006). The incidences of SjvO2 <50% and mean arterial pressure less than 50 mmHg were lower in S/N group, but SctO2and the incidence of cerebral desaturation (more than 20% decrease from baseline) did not significantly differ between the groups. SctO2 and SjvO2 were only weakly correlated (β = 0.218, r2 = 0.133). Bland-Altman analysis showed a mean difference of -7.2% with 95% limit of agreement between -38.2% and 23.8%. Conclusions The margin of safety against impaired cerebral oxygenation is greater and SjvO2 is more preserved with S/N than with P/R anesthesia. SctO2 may not be reliable in detecting a low SjvO2 during the surgery in BCP.

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P1703Impact of prehospital epinephrine administration and quality of cardiopulmonary resuscitation on neurologically intact survival in out-of-hospital cardiac arrest patients with non-shockable rhythm

European Heart Journal ◽

10.1093/eurheartj/ehz748.0458 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

A Funada ◽

Y Goto ◽

H Okada ◽

T Maeda ◽

M Takamura

Keyword(s):

Cardiac Arrest ◽

Multivariate Logistic Regression Analysis ◽

Multivariate Logistic Regression ◽

High Quality ◽

Epinephrine Administration ◽

Hospital Arrival ◽

Shockable Rhythm ◽

Neurologically Intact ◽

Hospital Cardiac Arrest

Abstract Background The effects of prehospital epinephrine administration in combination with the quality of cardiopulmonary resuscitation (CPR) on neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients with non-shockable rhythm remains unclear. Purpose This study aimed to elucidate the effects of prehospital epinephrine administration in combination with the quality of CPR on neurologically intact survival in OHCA patients with non-shockable rhythm. Methods We analysed 118,732 adult OHCA patients with non-shockable rhythm from the All-Japan OHCA registry between 2011 and 2016 (29,989 emergency medical service [EMS]-witnessed arrests with EMS-initiated CPR [high-quality CPR] and 88,743 bystander-witnessed arrests with bystander-initiated CPR continued by EMS providers [low-quality CPR]). Patients who achieved prehospital return of spontaneous circulation without prehospital epinephrine administration were excluded. The primary outcome measure was 1-month neurologically intact survival (cerebral performance category 1 or 2; CPC 1–2). Time from collapse to prehospital epinephrine administration for patients with prehospital epinephrine administration, or to hospital arrival for patients without prehospital epinephrine administration was calculated and adjusted collectively in multivariate logistic regression analysis for 1-month CPC 1–2. Results Multivariate logistic regression analysis revealed that the time from collapse to prehospital epinephrine administration or to hospital arrival was negatively associated with 1-month CPC 1–2 (adjusted odds ratio [OR] 0.95 per 1-minute increment, 95% confidence interval [CI] 0.94–0.96). Compared with bystander-witnessed arrests without prehospital epinephrine administration, EMS-witnessed arrests with or without prehospital epinephrine administration were significantly associated with increased chances of 1-month CPC 1–2 (adjusted OR 2.04, 95% CI 1.50–2.75 and adjusted OR 1.97, 95% CI 1.57–2.48, respectively). Prehospital epinephrine administration was significantly associated with an increased chance of 1-month CPC 1–2 among bystander-witnessed arrests (adjusted OR 1.57, 95% CI 1.24–1.98), but not among EMS-witnessed arrests. EMS-witnessed arrests without prehospital epinephrine administration were significantly associated with an increased chance of 1-month CPC 1–2 compared with bystander-witnessed arrests with prehospital epinephrine administration (adjusted OR 1.26, 95% CI 1.01–1.56). Conclusions High-quality CPR is crucial for increasing neurologically intact survival in OHCA patients with non-shockable rhythm. The additional beneficial effects of prehospital epinephrine administration were observed only among OHCA patients with low-quality CPR.

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