1,721,007 research outputs found
Mean initial cerebral saturation during advanced life support in out-of hospital cardiac arrest patients, predictor of survival?
No full textThe prognostic value of bispectral index and suppression ratio monitoring after out-of-hospital cardiac arrest. A prospective observational study.
No full textBackground: We investigated the ability of bispectral index (BIS) monitoring to predict poor neurological outcome in out-of-hospital cardiac arrest (OHCA) patients fully treated according to guidelines.
Results: In this prospective, observational study, 77 successfully resuscitated OHCA patients were enrolled in whom BIS, suppression ratio (SR) and electromyographic (EMG) values were continuously monitored during the frst 36 h after the initiation of targeted temperature management at 33 °C. The Cerebral Performance Category (CPC) scale was used to defne patients’ outcome at 180 days after OHCA (CPC 1–2: good–CPC 3–5: poor neurological outcome). Using mean BIS and SR values calculated per hour, receiver operator characteristics curves were constructed to determine the optimal time point and threshold to predict poor neurological outcome. At 180 days post-cardiac arrest, 39 patients (51%) had a poor neurological outcome. A mean BIS value≤25 at hour 12 predicted poor neurological outcome with a sensitivity of 49% (95% CI 30–65%), a specifcity of 97% (95% CI 85–100%) and false positive rate (FPR) of
6% (95% CI 0–29%) [AUC: 0.722 (0.570–0.875); p=0.006]. A mean SR value≥3 at hour 23 predicted poor neurological with a sensitivity of 74% (95% CI 56–87%), a specifcity of 92% (95% CI 78–98%) and FPR of 11% (95% CI 3–29%) [AUC: 0.836 (0.717–0.955); p<0.001]. No relationship was found between mean EMG and BIS<25 (R2=0.004; p=0.209).
Conclusion: This study found that mean BIS≤25 at hour 12 and mean SR≥3 at hour 23 might be used to predict poor neurological outcome in an OHCA population with a presumed cardiac cause. Since no correlation was observed between EMG and BIS<25, our calculated BIS threshold might assist with poor outcome prognostication following OHCA.This work was supported by the Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
Mean initial cerebral saturation during advanced life support in out-of hospital cardiac arrest patients, predictor of survival?
No full textAccuracy of continuous thermodilution cardiac output by pulmonary artery catheter during therapeutic hypothermia in post-cardiac arrest patients
No full textCerebral saturation monitoring during cardiopulmonary resuscitation should be used as dynamic, rather than static, information.
No full textLCR
Accuracy of continuous thermodilution cardiac output by pulmonary artery catheter during therapeutic hypothermia in post-cardiac arrest patients
No full text
Increase in cerebral oxygenation during advanced life support in out-of-hospital patients is associated with return of spontaneous circulation
Full text linkIntroduction: By maintaining sufficient cerebral blood flow and oxygenation, the goal of cardiopulmonary resuscitation (CPR) is to preserve the pre-arrest neurological state. To date, cerebral monitoring abilities during CPR have been limited. Therefore, we investigated the time-course of cerebral oxygen saturation values (rSO(2)) during advanced life support in out-of-hospital cardiac arrest. Our primary aim was to compare rSO(2) values during advanced life support from patients with return of spontaneous circulation (ROSC) to patients who did not achieve ROSC. Methods: We performed an observational study to measure rSO(2) using Equanox T (Nonin, Plymouth, MI) from the start of advanced life support in the pre-hospital setting. Results: rSO(2) of 49 consecutive out-of-hospital cardiac arrest patients were analyzed. The total increase from initial rSO(2) value until two minutes before ROSC or end of advanced life support efforts was significantly larger in the group with ROSC 16% (9 to 36) compared to the patients without ROSC 10% (4 to 15) (P = 0.02). Mean rSO(2) from the start of measurement until two minutes before ROSC or until termination of advanced life support was higher in patients with ROSC than in those without, namely 39% +/- 7 and 31% +/- 4 (P = 0.05) respectively. Conclusions: During pre-hospital advanced life support, higher increases in rSO(2) are observed in patients attaining ROSC, even before ROSC was clinically determined. Our findings suggest that rSO(2) could be used in the future to guide patient tailored treatment during cardiac arrest and could therefore be a surrogate marker of the systemic oxygenation state of the patient.The authors wish to thank the residents, nursing and medical staff of the emergency unit of Ziekenhuis Oost-Limburg for their cooperation and support in this study. They also want to thank Francesca Solmi for statistical support and Eric Caers for English grammar advice. This study is part of the Limburg Clinical Research Program UHasselt-ZOL-Jessa, supported by the foundation Limburg Sterk Merk, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital
The Association Between Global Hemodynamics, Cerebral Oxygenation and Survival in Post-Cardiac Arrest Patients
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